A case of systemic polyarteritis nodosa with spermatic cord involvement

• Published in: Nature clinical practice urology Vol. 5; no. 8; pp. 462 - 466
• Main Authors: Colegrove, Peter, Bush, Nicol C, Maxwell, Kelly M, Hamoui, Nabeel
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.08.2008; Nature Publishing Group
• Subjects: Biopsy; Blood pressure; Care and treatment; Case studies; case-study; Cerebrospinal fluid; Diagnosis; Diagnostic tests; Diarrhea; Emergency medical care; Erythema; Headaches; Hepatitis; Humans; Hypertension; Inflammation; Male; Medicine; Medicine & Public Health; Middle Aged; Pain; Patient outcomes; Patients; Periarteritis nodosa; Physiological aspects; Polyarteritis Nodosa - diagnosis; Polyarteritis Nodosa - drug therapy; Prednisone - pharmacology; Prednisone - therapeutic use; Proteins; Rheumatology; Risk factors; Spermatic cord; Spermatic Cord - drug effects; Spermatic Cord - pathology; Steroids; Testes; Ultrasonic imaging; Urinalysis; Urine; Urology; Veins & arteries; United States
• ISSN: 1743-4270; 1759-4812; 1743-4289; 1759-4820
• DOI: 10.1038/ncpuro1170

Polyarteritis nodosa is a rare systemic necrotizing vasculitis that requires urgent treatment. Asymptomatic scrotal involvement is relatively common, although symptomatic involvement is rarer. In this Case Study, Bush and colleagues highlight how urological evaluation including scrotal biopsy can enable rapid diagnosis of the disease and allow appropriate immunosuppressive therapy to be administered in a timely manner. Background A 50-year-old man with a history of hyperlipidemia and hypertension presented to an emergency department after 10 days of fevers (temperature 40 °C), headache, malaise, myalgia, poor appetite, diarrhea, and weight loss of 6.35 kg. He would subsequently develop bilateral scrotal swelling and pain during his evaluation. Investigations Investigations Physical examination, CBC, blood chemistry panel, measurement of erythrocyte sedimentation rate and C-reactive protein level, liver function profile, urinalysis, lumbar puncture, blood cultures, urine cultures, cerebrospinal fluid culture, stool analysis and cultures, multiple viral studies including hepatitis serologies, measurement of antineutrophil cytoplasmic autoantibody levels, urine protein electrophoresis, serum protein electrophoresis, CT of the head, chest, abdomen and pelvis, MRI of the brain, temporal artery biopsy and pathologic analysis, scrotal ultrasonography, right spermatic cord biopsy and pathologic analysis. Diagnosis Diagnosis Polyarteritis nodosa with involvement of both spermatic cords. Management Management Prednisone 60 mg daily was started for presumed temporal arteritis, but was discontinued when no evidence of arteritis was found in the temporal artery biopsy specimen. When pathologic analysis of the spermatic cord biopsy tissue confirmed polyarteritis nodosa, prednisone 40 mg twice daily was administered and the patient's scrotal pain and swelling resolved quickly. Steroids were slowly tapered and discontinued over the next 18 months. He remained free of systemic symptoms, with normal results on physical examination and laboratory evaluation, including urinalysis, CBC, erythrocyte sedimentation rate and C-reactive protein level, 5.5 months after discontinuation of glucocorticoid therapy.