A funny case of Funiculitis

Background: Funiculitis, an inflammation of the spermatic cord, usually results from infection of adjacent structures like the epididymis, testis or the urethra. It is most frequently caused by a bacterial infection, but has a broad (non-infectious) differential diagnosis.Methods: This case illustrates an unusual cause of funiculitis. A 72-year old man presented with sequential right- and left side funiculitis. He was non-responsive to antibiotics and developed constitutional symptoms. A non-infectious inflammatory etiology was suspected and further diagnostic procedures were performed.Results: PET findings suggested medium and large vessel vasculitis. CT angiography and histopathological analysis of the spermatic cord lacked the typical characteristics of Polyarteritis Nodosa (PAN) or medium size vasculitis. In light of a probable medium vessel vasculitis the patient was treated with corticosteroids, with a favorable response.Conclusion: Vasculitis should be considered in the differential diagnosis of a funiculitis that does not respond to antibiotic therapy. PET CT is an important tool for the diagnosis of vasculitis in patients with an atypical presentation and inconclusive diagnostic testing.