Polyarteritis nodosa with bilateral asynchronous testicular necrosis: a case report

Abstract

Polyarteritis nodosa (PAN) is a systemic vasculitis which may result in thrombosis or aneurysm formation in any organ of the body. We report a case polyarteritis nodosa (PAN) resulting in bilateral asynchronous testicular necrosis. A 55-year-old male developed acute onset of left testicular pain resulting in a left orchiectomy and right orchidopexy for an ischemic left testicle without evidence of torsion. Three weeks later, the patient developed acute right-sided scrotal pain, and surgical exploration revealed a right necrotic testicle resulting in a right orchiectomy. Pathologic evaluations demonstrated benign testes with acute interstitial hemorrhage and focal atrophy. The patient also experienced abdominal skin necrosis, penile pain and swelling, and temporary loss of vision. This is a unique case of PAN and the only case of asynchronous testicular necrosis in the medical literature.

Figure 1

Scrotal ultrasound images with color Doppler showing decreased blood flow to the left testicle (a) and right testicle (b). Both images are in the sagittal view.

Figure 2

Hematoxylin and eosin stains (100x). Testicular specimen showing thrombotic vasculopathy, intravascular papillary endothelial hyperplasia (IPEH), and recanalization.

Figure 3

Hematoxylin and eosin stains (600x). Skin biopsy demonstrating fibrin thrombus in the vessel lumen consistent with a clot (black arrow) and fibrin deposition in a postcapillary venule wall with surrounding granulocytic debris, consistent with a leukocytoclastic vasculitis (white arrow).