Bilateral Testicular Infarction from IgA Vasculitis of the Spermatic Cords

Figure 1

Evaluation of skin biopsy, renal biopsy, and orchiectomy specimens from the 51-year-old man. (a) Hematoxylin and eosin stained section revealed surface ulceration in the skin. (b) IgA immunofluorescence was positive in epidermis and vessels of dermis. (c) Hematoxylin and eosin stained section revealed mesangial expansion with focal neutrophil aggregation in the glomerulus. (d) IgA immunofluorescence was positive mainly in the mesangium and some along the glomerular capillary loops. (magnifications ×400 in (a)–(d)). (e) A low power view (×40) revealed the unremarkable vas deferens at the right lower corner and necrosis and abscess in the testicular parenchyma at the left upper corner. (f) Vasculitis was seen in multiple small arteries of spermatic cord at medium power view (×200). (g) High power view (×400) revealed organizing thrombus in a small artery causing nearly total occlusion of the vessel in the spermatic cord. (h) IgA immunofluorescence (×200) was positive (green granular staining) at the endothelium of multiple inflamed small arteries. Hematoxylin and eosin stains were performed in (e)–(g).

(a) Skin biopsy

(b) IgA positive in vessels and epithelium

(c) Renal biopsy

(d) IgA positive in glomerulus

(e) Spermatic cord margin

(f) Vasculitis in spermatic cord

(g) Organizing thrombosis

(h) Positive IgA staining in small arteries