Polyarteritis nodosa presenting with frank hematuria.

Area of Science:

• Nephrology
• Urology
• Rheumatology

Background:

• Polyarteritis nodosa (PAN) is a rare systemic vasculitis affecting small to medium arteries.
• PAN typically presents with non-specific symptoms, making diagnosis challenging.
• Urological manifestations of PAN at initial presentation are exceptionally uncommon.

Purpose of the Study:

• To report an atypical case of Polyarteritis nodosa presenting with urological symptoms.
• To highlight the importance of a multidisciplinary approach in diagnosing rare vasculitides.
• To increase awareness of unusual PAN presentations in clinical practice.

Main Methods:

• Case report of a 65-year-old male with atypical Polyarteritis nodosa.
• Clinical evaluation including urological assessment, laboratory tests (ANCA, ESR), and imaging.
• Multidisciplinary team discussion involving urology, radiology, and nephrology.

Main Results:

• The patient presented with left testicular pain, swelling, and an intratesticular lesion.
• Painless visible hematuria developed during the diagnostic workup.
• Positive anti-neutrophil cytoplasmic antibody (ANCA) and elevated erythrocyte sedimentation rate (ESR) supported the diagnosis.
• No arteriovenous fistula or false aneurysm was identified.

Conclusions:

• Polyarteritis nodosa can manifest with rare urological symptoms, including testicular involvement and hematuria.
• A high index of suspicion and integrated diagnostic efforts are crucial for identifying atypical PAN cases.
• Multidisciplinary collaboration is essential for the timely and accurate diagnosis of complex vasculitic conditions like PAN.