Toushan Mazen, Atodaria Ashka, Lynch Stephen D, Kanaan Hassan D, Yu Limin, Amin Mitual B, Tahhan Mamon, Zhang Ping L, Kellerman Paul S, Swami Abhishek
Division of Anatomic Pathology, Department of Pathology, Beaumont Health, Royal Oak, MI, USA.
Department of Internal Medicine, Beaumont Health, Royal Oak, MI, USA.
Case Rep Nephrol. 2017;2017:9437965. doi: 10.1155/2017/9437965. Epub 2017 Nov 21.
A 51-year-old man with type 2 diabetes mellitus and chronic obstructive pulmonary disease presented to the emergency room with increasing bilateral leg pain, rash, and scrotal swelling with pain. Skin biopsy from his thigh revealed IgA-associated vasculitis. Due to hematuria, a renal biopsy was performed and showed an IgA glomerulonephritis with focal fibrinoid necrosis and neutrophil accumulation. Bilateral orchiectomies were performed in two separate procedures ten and thirteen days after the renal biopsy, as a result of uncontrolled abscess formation in testicles. Microscopically, both testicles revealed large abscess formation destroying almost the entire testicular parenchyma without tumor cells. Spermatic cord margins were further scrutinized microscopically to show bilateral vasculitis in many small size vessels, confirmed by positive endothelial staining for IgA. Some of the affected arteries revealed central organizing thrombi with recanalization features, highly suggestive of vasculitis-associated thrombi formation, resulting in testicular ischemic infarction and abscess formation. We conclude that this adult patient developed a severe form of Henoch-Schönlein purpura, with vasculitis affecting multiple organs, including the most serious and unusual complication of bilateral testicular infarction.
一名患有2型糖尿病和慢性阻塞性肺疾病的51岁男性因双侧腿部疼痛加剧、皮疹以及阴囊肿胀伴疼痛而就诊于急诊室。大腿皮肤活检显示为IgA相关性血管炎。因出现血尿，遂进行肾活检，结果显示为IgA肾小球肾炎，伴有局灶性纤维蛋白样坏死和中性粒细胞聚集。肾活检后第10天和第13天，分两次进行了双侧睾丸切除术，原因是睾丸内脓肿形成无法控制。显微镜下，双侧睾丸均显示有大脓肿形成，几乎破坏了整个睾丸实质，未见肿瘤细胞。对精索边缘进行显微镜检查，发现许多小血管存在双侧血管炎，IgA内皮染色阳性得以证实。部分受累动脉显示中央有组织化血栓并具有再通特征，强烈提示血管炎相关血栓形成，导致睾丸缺血性梗死和脓肿形成。我们得出结论，该成年患者发生了严重形式的过敏性紫癜，血管炎累及多个器官，包括最严重且不常见的双侧睾丸梗死并发症。
