Testicular Pain and Swelling Can Be Initial Sign of ANCA-associated Vasculitis, Case Report Finds

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by Alice Melão |

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Pain and swelling in the testes, in rare cases, may be the first symptoms of ANCA-associated vasculitis, even among patients without other symptoms associated with this disease, researchers reported, noting that testicular vasculitis is often misdiagnosed.

The study, “Testicular granulomatous vasculitis mimicking testicular torsion in an anti-neutrophil cytoplasmic antibody–associated vasculitis patient,” was published in SAGE Open Medical Case Reports.

ANCA-associated vasculitis is an auto-immune condition characterized by inflammation and damage to blood vessels. It most often affects the lungs, kidneys, stomach, and intestine, but blood vessels virtually anywhere in the body can be involved.

Inflammation of testicular blood vessels — or testicular vasculitis – is a rare manifestation of ANCA vasculitis, and commonly mistaken as an infection, testicular torsion, or a tumor, particularly when such inflammation is the only symptom.

Removing the patient’s testes, or testicles, is common treatment, either because of a misdiagnosis or because the disease was diagnosed too late.

Researchers at Baylor College of Medicine detail the case of a 63-year-old man with testicular symptoms, adding their work appears to be “the first to report testicular involvement as the first manifestation in an ANCA-associated vasculitis patient.”

The man complained of testicular pain and swelling that failed to respond to, or ease with, antibiotic use. He also experienced weight loss, fatigue, pain, and swelling in both legs.

Analysis revealed deep venous thrombus — blood clots blocking the vessels — in his legs, as well as abnormal lymph nodes (lymphadenopathy), anemia, and a low number of white blood cells. Blood tests also came back positive for the hepatitis B virus.

After seven days in the hospital, the patient developed sudden severe pain in his left testicle, caused by a lack of blood flow. He underwent emergency surgery to remove the testicle, but an exploratory exam failed to identify a cause for the lack of blood supply.

Looking at microscopic structures in the testicle, researchers found signs of inflammation, immune cell infiltration, localized bleeding, and scarring. They suspected systemic vasculitis, which was confirmed through additional blood work — the patient was positive for ANCA antibodies and showed signs of systemic inflammation.

The man was diagnosed with ANCA-associated vasculitis with testis and possibly lung involvement, for which he started taking prednisone. On his last follow-up, he was doing well, with no signs of disease recurrence.

“Our case is the first to report testicular involvement as the first manifestation in an ANCA-associated vasculitis patient,” the researchers wrote.

“It is important to include [testicular vasculitis] as a differential diagnosis for a patient presenting with testicular pain or swelling even without systemic symptoms,” they added. “Immediate recognition … can help achieve accurate diagnosis and appropriate treatment.”