Raoultella planticola is an uncommon yet emerging Gram-negative pathogen primarily associated with urinary tract infections (UTIs), but never previously reported as a causative agent in epididymo-orchitis (EO). This case represents the first documented instance of R. planticola-induced EO, highlighting the pathogen’s underestimated potential for severe urogenital infection, especially in immunocompromised patients. The case underscores the necessity for heightened awareness and vigilance among urologists managing atypical presentations of EO.

We report the clinical course of a 76-year-old immunocompromised male with a medical history significant for chronic lymphocytic leukaemia, Type 2 Diabetes Mellitus, and chronic kidney disease who presented initially with campylobacter gastroenteritis. Following this presentation, he developed bilateral scrotal symptoms suggestive of EO. Diagnostic evaluations included detailed urinalysis, blood and stool cultures, microbiological susceptibility testing, and scrotal ultrasound imaging.

The patient’s clinical presentation evolved from confirmed campylobacter gastroenteritis to bilateral EO, initially managed unsuccessfully with azithromycin. Subsequent urine cultures revealed R. planticola, resistant to penicillins and tetracycline but sensitive to ciprofloxacin. Targeted antibiotic therapy with ciprofloxacin resulted in complete symptomatic resolution. Imaging confirmed bilateral epididymo-orchitis with significant hyperemia and scrotal wall thickening. This case demonstrates R. planticola’s opportunistic pathogenicity, notably in an immunosuppressed host, and highlights the clinical importance of precise microbiological identification and tailored antimicrobial therapy.

This first reported case of Raoultella planticola epididymo-orchitis significantly broadens the known clinical spectrum of this organism. It emphasises the importance of considering atypical pathogens in immunocompromised patients presenting with unusual EO. Enhanced clinician awareness, accurate microbiological diagnostics, and susceptibility-driven antimicrobial strategies are critical for effective management and for preventing antibiotic resistance in emerging pathogens.