Danilo Sirigu MD
Azienda Ospedaliera Brotzu, Cagliari

VIDEO CASE:
Henoch-Schonlein purpura in a 9-year-old boy with bilateral scrotal pain and swelling.
Transverse and longitudinal US scan of the scrotum reveal marked thickening of the scrotal walls and right
epididymal enlargement with heterogeneous echo pattern and reactive hydrocele.( VIDEO 1; photo 1 )
The echotexture of the testis is normal.
Color flow Doppler images reveal increased flow in the scrotal walls and in the right epididymis with normal
flow in the testis.( VIDEO 2; photo 2 )
The patient was treated with steroid therapy that has led to a complete regression of the symptoms and
ultrasound findings after 7 days (VIDEO 3 ; photo 3)

DISCUSSION:
Henoch-Schönlein purpura is a systemic vasculitis with immune complexes deposition in capillaries, arterioles
and venules. It mostly affects skin, joints, kidney, bowel, and, less often, brain, lung and gonads.
Capillary lesions and hemorrhagic outcomes may determine necrosis focuses which, in rare cases may
determine, in the pediatric male patient, a case history of acute scrotum, sometimes hardly differentiable from
spermatic cord torsion.
Acute scrotal pain with epididymitis is rarely reported with HSP.Scrotal or testicular involvement is estimated in
15-38 % of patients with Henoch-Schonlein purpura .
Ultrasonographic evaluation plays an essential role in diagnosis, showing, in the most typical cases, notable
edematous hemorrhagic phenomena al the level of the scrotal tunics, with possible acute epididymitis and
reactive hydrocele.
Testicles are not usually involved and retain a normal vascularization.
In these cases a treatment with steroids is helpful.

References:
- Hall RP, Lawley TJ, Heck JA, Katz SI. IgA-containing circulating immune complexes in dermatitis herpetiformis Henoch-Schonlein purpura systemic
lupus erythematosus and other disease.Clin Exp Immunol 1980;40:431J437
 
- Khan AU, Williams TH, Malek RS. Acute scrotal swelling in Henoch-Schonlein syndrome. Urology 1977;10:139J141 Turkish VJ, Traisman HS, Belman
AB, Given GZ, Marr TJ. Scrotal swelling in the Henoch-Schonlein syndrome. J Urol 1976;115:317J319

- Chun-Jung Chen, Chih-Chun Chu, Mu-Ling Hsu, Chung-Ping Lo, Tsyr-Yuh Ho, and Shin-Nan Cheng Epididymitis in Henoch-Schonlein Purpura. J Med
Sci 2003;23(1):53J56 .

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