A case of scrotal swelling mimicking testicular torsion preceding Henoch-Schönlein vasculitis

Abstract

Henoch-Schönlein purpura, is one of the most common types of multisystemic vasculitis seen in childhood. The major clinical manifestations are cutaneous purpura, arthritis, abdominal pain, gastrointestinal bleeding, and nephritis. Isolated central nervous system vasculitis, seizures, coma and hemorrhage, Guillan--Barré syndrome, ataxia and central and peripheral neuropathy, ocular involvement, orchitis, epididymitis or testicular torsion are medical or surgical complications. In this study, we report a 7-year-old boy with scrotal swelling mimicking testicular torsion with ultrasonographic and clinical fi ndings that the typical clinical features of Henoch-Schönlein purpura including rashes and arthritis were developed after one week of surgery (Ref. 15) Henoch-Schönlein purpura (HSP) is one of the most common types of multisystemic vasculitis seen in childhood and characterized by non-thrombocytopenic, non-blanching purpura, arthritis, abdominal pain, and renal involvement (1). The epidemiology of HSP is obscure and in the literature there are different values of incidence of this disease. An incidence of 13.5 cases per 100,000 children per year was observed by Stewart M. et al. whereas 0.2-10 cases per 100,000 were reported by Farley et al (2, 3). Although the major clinical manifestations are cutaneous purpura, arthritis, abdominal pain, gastrointestinal bleeding, and nephritis, other manifestations include an isolated central nervous system vasculitis, seizures, coma and hemorrhage, Guillan-Barré syndrome, ataxia and central and peripheral neuropathy, ocular involvement, orchitis, epididymitis or testicular torsion are other medical or surgical conditions that can be seen with HSP (4). The present report details a case of a young Turkish boy with scrotal swelling mimicking testicular torsion with ultrasonographic fi ndings and with the typical clinical features of HSP developed one week after the surgery. Case reportA 7-year-old boy was brought to emergency department with complaints of scrotal swelling and pain lasting 1 day. Except a history of brucellosis 2 years ago, the personal and family histories were unremarkable. Moreover, recent history of infectious disease or trauma was not described. At the time of admission, there were left scrotal edema and testicular pain and he had no rash in any part of the body. The laboratory investigations revealed hemoglobin 13.1 g/dl, white blood cell count 13000/μL and platelet count 462,000/μL. Serum electrolytes, liver enzymes, blood coagulation tests, antinuclear antibody, rheumatoid factor, antistreptolysin O, serum IgA level and urinalysis were within normal levels. On ultrasonographic examination decreased blood fl ow and enlarged testis were seen. Surgical exploration revealed a hematocele, with bloody fl uid accumulation mainly in the tunica vaginalis testis and an edematous, hyperemic testis and epydidymis without torsion of both of them. Edema of testis and epydidymis resolved after surgery. The patient was discharged without any complication on t...

A Rare Cause of Acute Scrotal Pain in Paediatric Patients; A Questionnaire Survey and Literature Review

“…In clinical practice, extreme tenderness over the affected area hampers adequate scrotal examination in children and often the diagnosis is difficult to establish simply on clinical grounds 7 . Thus, most patients undergo exploration 8 . Some authors have advocated the use of ultrasound study as an adjunct to aid the diagnosis, but this is user-dependent and may miss acute testicular…”

Henoch-Schönlein Purpura With Scrotal Involvement: A Case Report and Literature Review

“… 7 , 8 , 11 , 12 , 15 , 17 , 19 , 25 Four (19%) patients had fever, 6 , 16 , 22 , 26 9 (42%) patients had joint involvement, 7 , 13 – 16 , 21 – 23 , 25 2 (9%) patients had penis involvement, 7 , 8 and hematuria was found in 2 (9%) cases. 11 , 12 Regarding the onset of HSP and scrotal involvement, 14 cases of scrotal involvement manifested after the onset of HSP (67%), 7 , 8 , 12 , 15 , 17 – 20 , 22 , 23 , 25 , 26 5 cases were before the onset of HSP (24%), 11 , 13 , 14 , 16 , 24 and 2 cases occurred simultaneously with HSP (9%). 5 , 21 It shows that scrotal involvement can occur at any point in relation to the diagnosis of HSP.…”

Decreased Blood Flow in the Testis: Is it Testicular Torsion?

“…Other vasculitides that may involve the testes and result in the absence of testicular blood flow include vasculitis in systemic lupus erythematosus, granulomatosis with polyangiitis, giant cell arteritis, and Henoch-Schonlein purpura. [18,19]…”