Testicular ischemia secondary to non-responding epididymitis to antibiotics is rare.

Color flow Doppler ultrasound is required to assess the involved testis in patients with epididymitis who respond initially to antibiotics and later develop pain, tenderness and fevers during the course of treatment.

In this case, no flow was detected six days after initial antibiotic therapy and patient had ongoing pain, tenderness and febrile episodes while on broad-spectrum IV antibiotics.

Surgical exploration and orchiectomy were performed after color flow Doppler ultrasound showed no flow in the affected testis.