Polyarteritis nodosa presenting with frank hematuria

Abstract

Polyarteritis nodosa (PAN) is an uncommon systemic vasculitis characterized by necrotizing inflammation of small- or medium-sized arteries. The disease normally presents with non-specific symptoms. Urological symptoms at presentation are extremely rare. We report a 65-year-old man who was diagnosed with a polyarteritis nodosa having presented atypically with left testicular pain and swelling, and an intratesticular lesion. He developed painless visible hematuria while under investigation. No gross arterio-venous fistula was seen to suggest a false aneurysm. Subsequently, laboratory studies showed positive anti-neutrophil cytoplasmic antibody levels and a raised erythrocyte sedimentation rate. This was an unusual presentation of PAN diagnosed with multidisciplinary input from the urology, radiology and nephrology teams.

Fig. 1

A testicular ultrasound, suggesting the possibility of mycotic aneurismal lesions.

Fig. 2

A computed tomography scan showing a renal parenchymal aneurysm.

Fig. 3

The renal angiogram revealing multiple aneurysms and segmental infarct.

Fig. 4

The mesenteric angiogram showing an aneurysm in the pancreatic head.