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

Abstract

Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood and affects the small blood vessels, leading to arthritis, abdominal pain, and renal involvement. However, scrotal involvement is a rare complication of HSP and scrotal pain. Swelling is the most frequent clinical presentation and can be easily confused with testicular torsion. If not treated in time, the scrotal inflammation will result in irreversible testicular necrosis. We report a 6-year-old male with HSP and scrotal involvement, characterized by swelling and pain on the left side of the scrotum, rashes on both lower extremities, and epididymitis. He was treated with conservative care, corticosteroids, and antibiotic therapy. We were able to avoid surgical intervention. On the 10 days of treatment, he recovered sufficiently well and was discharged. We have reviewed the literature related to HSP with scrotal involvement, identified 21 cases, and revealed that steroid therapy and/or antibiotics are the first-line of therapy in children with scrotal involvement. Vasculitis in the scrotum may predispose to testicular torsion, which is a complication that should not be overlooked. Clinicians should be aware of the atypical types of HSP. Timely diagnosis and appropriate treatment are essential for achieving the best results.

External Male Genitalia in Henoch–Schönlein Syndrome: A Systematic Review

“…The external genitalia are implicated in every fifth male with Henoch–Schönlein syndrome [ 1 , 2 ]. Integrating and complementing the results of a recent review analyzing Henoch–Schönlein syndrome with scrotal involvement in 21 children [ 82 ], the discussion of this review will address the temporal relationship between the distinctive features of this vasculitis and the genital participation, the histopathology features, and the characteristics of penile and scrotal involvement, with emphasis on the ischemic testicular damage, and management.…”

Scrotal involvement in childhood immunoglobulin A associated vasculitis

“…Acute scrotum, ureteritis, bladder wall hematoma, hemorrhagic spermatic cord, thrombosis of spermatic veins, and epididymo-orchitis may develop as extrarenal genitourinary manifestations in IgAV patients. [8] The first case of IgAV male genital involvement was published in 1960 and it was shown that 2-38% of IgAV patients may develop scrotal involvement. [9,10] In 2021, Ma et al reviewed IgAV patients with scrotal involvement in the literature.…”

“…[9,10] In 2021, Ma et al reviewed IgAV patients with scrotal involvement in the literature. [8] Between 1986 and 2020, 21 case reports of children with IgAV showed describing scrotal involvement. The mean age of onset of IgAV with scrotal involvement was 5.69±2.12 years.…”

“…Scrotal involvement of disease usually results in pain, tenderness, swelling or bruising of scrotum. [8] Although pediatricians are well aware of the typical clinical features of IgAV, they may not be sufficiently familiar with its other rare findings such as scrotal involvement and its approach. The aim of this study is to evaluate the demographic and clinic findings in IgAV patients with scrotal involvement and also to determine predictive factors for assessing the development of scrotal involvement.…”

Testicular Torsion Associated with Henoch-Schönlein Purpura

“…6 Acute scrotum associated with HSP is treated conservatively. 7 Because testicular torsion may occur and requires…”