Bilateral Testicular Infarction from IgA Vasculitis of the Spermatic Cords

Abstract

A 51-year-old man with type 2 diabetes mellitus and chronic obstructive pulmonary disease presented to the emergency room with increasing bilateral leg pain, rash, and scrotal swelling with pain. Skin biopsy from his thigh revealed IgA-associated vasculitis. Due to hematuria, a renal biopsy was performed and showed an IgA glomerulonephritis with focal fibrinoid necrosis and neutrophil accumulation. Bilateral orchiectomies were performed in two separate procedures ten and thirteen days after the renal biopsy, as a result of uncontrolled abscess formation in testicles. Microscopically, both testicles revealed large abscess formation destroying almost the entire testicular parenchyma without tumor cells. Spermatic cord margins were further scrutinized microscopically to show bilateral vasculitis in many small size vessels, confirmed by positive endothelial staining for IgA. Some of the affected arteries revealed central organizing thrombi with recanalization features, highly suggestive of vasculitis-associated thrombi formation, resulting in testicular ischemic infarction and abscess formation. We conclude that this adult patient developed a severe form of Henoch-Schönlein purpura, with vasculitis affecting multiple organs, including the most serious and unusual complication of bilateral testicular infarction.

IgA Vasculitis with scrotal involvement - a rare presentation in adults

“…Scrotal involvement in adults is only described in a few cases, with apparent different findings on ultrasonography. Only three of the reviewed cases reported ultrasonography results and, unlike children, some presented testicular morphologic changes and diminished doppler sign [ 17 , 18 ], which is concordant with this case report. These results emphasize the need for research and additional studies on this group, to better understand scrotal involvement, its severity and its consequences.…”

Testicular ischemia associated with IgA vasculitis in a child: a case report and literature review

“…The vast majority of the cases have been reported in men and involved the scrotum, penis, epididymis, testicles, and spermatic cord. Cases involving testicular blood vessels may be complicated with epididymitis or epididymo-orchitis ( 7 , 8 , 10 ), testicular torsion ( 14 ), and spermatic vein thrombosis ( 9 , 15 ), all of which are risk factors for testicular necrosis that can lead to testicular ischemia and necrosis if not timely treated.…”

“…The other two cases developed left testicular necrosis and underwent testicular resection ( 7 , 8 ). Bilateral testicular necrosis occurred in one patient with bilateral spermatic cord thrombosis, which was resolved by orchiectomy ( 9 ).…”

“…Genital involvement in IgAV is infrequent, and testicular necrosis is extremely rare. To the best of our knowledge, only four cases of testicular necrosis have been reported worldwide (7)(8)(9)(10). Recently, a boy with IgAV experiencing abdominal pain and testicular ischemia was treated in our hospital.…”