title: Testicular pain followed by microscopic hematuria, a renal mass, palpable purpura, polyarthritis, and hematochezia.
abstract: We present the instructive case of a man who developed progressively severe testicular pain. He sought the medical care of several physicians, including general medicine, urology, and rheumatology. What began with focal testicular pain evolved over the ensuing weeks to a multisystem disorder affecting at least 3 additional organ systems beyond the genitourinary tract. Leukocytoclastic vasculitis was diagnosed, affecting the skin, joints, kidney, and gastrointestinal tract with predominant IgA deposition consistent with underlying Henoch-Schönlein purpura in the setting of renal cell carcinoma. This case illustrates and reinforces both the importance of considering an occult malignancy in a patient who presents with symptoms suggestive of a systemic vasculitis as well as the importance of considering an occult vasculitis in the adult male patient presenting with testicular pain.
authors.affiliation: Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Janet W
authors.initials: JW
authors.lastname: Maynard
authors.forename: Lisa
authors.initials: L
authors.lastname: Christopher-Stine
authors.forename: Allan C
authors.initials: AC
authors.lastname: Gelber
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001168:Arthritis / Q000175:diagnosis / Q000209:etiology*; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006417:Hematuria / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D007680:Kidney Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D010146:Pain / Q000175:diagnosis / Q000209:etiology*; D011241:Prednisone / Q000627:therapeutic use; D013733:Testicular Diseases / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D011241:Prednisone