A 16-year-old boy is brought to the emergency department for evaluation of testicular pain and
scrotal swelling. He had an episode of bilateral facial swelling along the jawline several days ago with associated fevers,
headaches, and myalgias. The pain is worsened with movement. He has no dysuria. He is not sexually active. Records demonstrate his parents refused
vaccinations throughout childhood. Temperature is 38.2°C (100.7°F),
pulse is 98/min, and
blood pressure is 122/84 mmHg. Physical examination reveals bilaterally enlarged and tender
testicles. Stroking of the inner thigh bilaterally results in elevation of the
testes. Which of the following is the most likely etiology of this patient’s clinical condition?
