Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Case Study
  • Published:

A case of systemic polyarteritis nodosa with spermatic cord involvement

Nature Clinical Practice Urology volume 5, pages 462–466 (2008)Cite this article

Abstract

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Scrotal ultrasound scan of the case patient.
Figure 2: Light microscopy of the biopsy specimen from the case patient showing necrotizing vasculitis.

References

  1. Kussmaul A and Maier R (1866) Ueber eine bisher nicht beschriebene eigenthümliche Arterienerkrankung (Periarteritis nodosa), die mit Morbus Brightii und rapid fortschreitender allgemeiner Muskellähmung einhergeht. Dtsch Arch Klin Med 1: 484–518

    Google Scholar 

  2. Segelmark M and Selga D (2007) The challenge of managing patients with polyarteritis nodosa. Curr Opin Rheumatol 19: 33–38

    Article  Google Scholar 

  3. Jennette JC et al. (1994) Nomenclature of systematic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 37: 187–192

    Article  CAS  Google Scholar 

  4. Généreau T et al. (1999) Temporal artery biopsy: a diagnostic tool for systemic necrotizing vasculitis. French Vasculitis Study Group. Arthritis Rheum 42: 2674–2681

    Article  Google Scholar 

  5. Guillevin L et al. (2005) Hepatitis B virus-associated polyarteritis nodosa: clinical characteristics, outcome, and impact of treatment in 115 patients. Medicine (Baltimore) 84: 313–322

    Article  Google Scholar 

  6. Guillevin L et al. (1995) Polyarteritis nodosa related to hepatitis B virus. A prospective study with long-term observation of 41 patients. Medicine (Baltimore) 74: 238–253

    Article  CAS  Google Scholar 

  7. Selga D et al. (2006) Polyarteritis nodosa when applying the Chapel Hill nomenclature—a descriptive study on ten patients. Rheumatology (Oxford) 45: 1276–1281

    Article  CAS  Google Scholar 

  8. Colmegna I and Maldonado-Cocco JA (2005) Polyarteritis nodosa revisited. Curr Rheumatol Rep 7: 288–296

    Article  Google Scholar 

  9. Lightfoot RW Jr et al. (1990) The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum 33: 1088–1093

    Article  Google Scholar 

  10. Sørensen SF et al. (2000) A prospective study of vasculitis patients collected in a five year period: evaluation of the Chapel Hill nomenclature. Ann Rheum Dis 59: 478–482

    Article  Google Scholar 

  11. Pettigrew HD et al. (2007) Polyarteritis nodosa. Comp Ther 33: 144–149

    Article  Google Scholar 

  12. Dahl EV et al. (1960) Testicular lesions of periarteritis nodosa, with special reference to diagnosis. Am J Med 28: 222–228

    Article  CAS  Google Scholar 

  13. Fraenkel-Rubin M et al. (2002) Limited polyarteritis nodosa of the male and female reproductive systems: diagnostic and therapeutic approach. Ann Rheum Dis 61: 362–364

    Article  CAS  Google Scholar 

  14. Lee LM et al. (1983) Testicular pain: an unusual presentation of polyarteritis nodosa. J Urol 129: 1243–1244

    Article  CAS  Google Scholar 

  15. Persellin ST and Menke DM (1992) Isolated polyarteritis nodosa of the male reproductive system. J Rheumatol 19: 985–988

    CAS  PubMed  Google Scholar 

  16. Mukamel E et al. (1995) Testicular mass as a presenting symptom of isolated polyarteritis nodosa. Am J Clin Pathol 103: 215–219

    Article  CAS  Google Scholar 

  17. Teichman JM et al. (1993) Polyarteritis nodosa presenting as acute orchitis: a case report and review of the literature. J Urol 149: 1139–1140

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. NC Bush is a Pediatric Urology Fellow at Children's Medical Center, Dallas, TX ,

    Nicol C Bush

  2. KM Maxwell is a Resident in Urology, Chicago, IL ,

    Kelly M Maxwell

  3. N Hamoui is a Resident in Radiology at Northwestern Memorial Hospital, Chicago, IL ,

    Nabeel Hamoui

  4. P Colegrove is an Attending Physician at Evanston Northwestern Healthcare System, Evanston, IL, USA.,

    Peter Colegrove

Authors
  1. Nicol C Bush
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kelly M Maxwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nabeel Hamoui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Colegrove
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Colegrove.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bush, N., Maxwell, K., Hamoui, N. et al. A case of systemic polyarteritis nodosa with spermatic cord involvement. Nat Rev Urol 5, 462–466 (2008). https://doi.org/10.1038/ncpuro1170

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro1170

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing