Korean J Urol.  2011 May;52(5):364-367.

Polyarteritis Nodosa Presenting with Bilateral Testicular Swelling and Complicated by Unilateral Facial Nerve Palsy

• Yuminaga Y
• Richards B
• Rasiah K
• Thanigasalam R
• Atmore BB
• Laurent R

Abstract

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that is generally restricted to medium-sized vessels. Here we describe the first case of a patient in which a bilateral testicular mass was a presenting symptom and the diagnosis was made on the basis of testicular histopathology. A 53-year-old Asian man presented with a history of constitutional symptoms and testicular swelling. Scrotal ultrasound revealed two avascular, bilateral, intratesticular lesions. The bilateral testicular abscess was treated without improvement. The patient developed left seventh cranial nerve palsy during his admission. The clinical changes made vasculitis or a related disorder more likely and the patient underwent a right testicular biopsy. Histopathology demonstrated features of transmural inflammation and fibrinoid necrosis of medium-sized vessel walls, consistent with PAN. This case illustrates the difficulty in diagnosing polyarteritis nodosa with isolated bilateral testicular swelling and the delay in the diagnosis. After 9 months of follow-up, no relapse had occurred and the patient's testosterone level was on the lower side of normal.

Keyword

Mononeuropathies; Polyarteritis nodosa; Systemic vasculitis; Testicular diseases

MeSH Terms

Abscess
Asian Continental Ancestry Group
Biopsy
Facial Nerve
Follow-Up Studies
Glycosaminoglycans
Humans
Inflammation
Middle Aged
Mononeuropathies
Necrosis
Paralysis
Polyarteritis Nodosa
Recurrence
Systemic Vasculitis
Testicular Diseases
Testosterone
Vasculitis
Glycosaminoglycans
Testosterone

Figure

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  FIG. 1 Ultrasound findings in the testicles: the right testicle showed a 2 cm heterogenous avascular lesion and the left testicle showed 2.3 cm and 2.1 cm heterogenous avascular lesions.

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  FIG. 2 Intraoperative findings in the testicle: the right testicle showed hemorrhagic necrosis.

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  FIG. 3 (A) Polyarteritis nodosa (PAN) of the testis at low power magnification (×10) showing a medium-sized arterial vessel with fibrinoid necrosis and transmural inflammatory cells (black arrow) surrounded by intertubular secondary hemorrhage. (B) PAN of the testis at high power magnification (×40) showing inflammation and fibrinoid necrosis of the vessel wall (clear arrow).

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