Mercer Ross, White Angus, Bates Christopher
School of Anatomy, University of Bristol, Bristol, UK.
Department of Urology, Aneurin Bevan University Health Board, Newport, UK.
J Surg Case Rep. 2022 Nov 26;2022(11):rjac548. doi: 10.1093/jscr/rjac548. eCollection 2022 Nov.
Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis encompasses a group of rare multi-system affecting diseases that can present with unremitting cases of common conditions. We present a case of a middle-aged gentleman admitted under Urology with epidymo-orchitits on multiple occasions. Ultrasound revealed segmental testicular infarcts, and he was managed conservatively. He re-presented shortly after discharge to the medical assessment unit with ulnar nerve paraesthesia, thought to be due to ulnar nerve entrapment syndrome. Less than 1 week later he was re-admitted again, with severe peripheral nerve pain in all limbs and multifocal weakness. Initial history and examination gave a provisional diagnosis of mononeuritis multiplex. Following investigations and treatment, this was deemed to be caused by a converging diagnosis of C-ANCA PR3 positive vasculitis, a small vessel vasculitis. This case highlights that patients with unremitting cases of epididymo-orchitis with testicular infarcts may benefit from autoimmune screening.
抗中性粒细胞胞浆抗体（ANCA）相关血管炎是一组罕见的多系统受累疾病，可表现为常见病症的持续不缓解情况。我们报告一例中年男性病例，该患者多次因附睾炎和睾丸炎入住泌尿外科。超声检查发现节段性睾丸梗死，对其进行了保守治疗。出院后不久，他因尺神经感觉异常再次就诊于医疗评估单元，考虑为尺神经卡压综合征所致。不到1周后，他再次入院，出现四肢严重的周围神经疼痛和多灶性无力。初步的病史和检查初步诊断为多发性单神经炎。经过进一步检查和治疗，发现这是由C-ANCA PR3阳性血管炎（一种小血管血管炎）的综合诊断引起的。该病例强调，对于患有持续性附睾炎伴睾丸梗死的患者，进行自身免疫筛查可能有益。
