3). As the patient Protein Tyrosine Kinase inhibitor was well and reluctant to have orchidectomy, a conservative management approach was adopted. Ultrasound scan performed 10 weeks from the first scan showed that the lesion had significantly decreased in size confirming the diagnosis of testicular infarction (Fig. 4). BD is a progressive vasculitic disease with a relapsing and remitting course. The prevalence in North America and Europe is 1 case per 15,000–500,000 population compared with 420 cases per 100,000 population in Turkey.1 and 2 The clinical manifestations presenting in most of the patients with BD are oral and genital ulcers, uveitis, and skin lesions. Other common clinical manifestations include arthritis,

thrombophlebitis, and various neurologic syndromes. Less frequent complications include arterial thrombosis, systemic and pulmonary circulation aneurysms, colitis, epididymitis, and orchitis.3 The frequency of epididymo-orchitis in BD has geographic variation and differs between juvenile

and adult patients. The highest frequency (44%) of epididymo-orchitis has been reported in Russia and the lowest (2%) in France. Epididymo-orchitis was noted in 11.3% of adult patients and 7.7% in children. The incidence of epididymo-orchitis was 31% in Iraqi but only 6% in Turkish patients.4 Zouboulis et al5 reported prostatitis click here and epididymo-orchitis with BD in 22% of cases. The etiology of epididymo-orchitis in patients with BD is not fully understood. Vasculitis causing inflammation has been proposed, but there is lack of histologic data. Infection has also been implicated; however, urinary cultures have consistently been negative in case series, and inflammation subsides with administration of anti-inflammatory drugs.4 and 6 Clinical presentation in different case series and reports was mainly as testicular pain, with testicular mass being less common.7, 8, 9 and 10 Testicular infarction is a rare entity, with <50 reported cases.8 Although vasculitis was reported as a cause for testicular infarction in 3-mercaptopyruvate sulfurtransferase few cases before,

none of these patients had BD. Case reports of polyarteritis nodosa as a cause of testicular infarction are described.9 and 10 In one case, a patient had bilateral testicular infarction and orchidectomy with subsequent androgen hormone replacement. In another case report, a 19-year-old man presented with unilateral testicular swelling and pain. The initial diagnosis of epididymo-orchitis was altered to testicular neoplasm after ultrasonography. Histologic examination after orchidectomy showed testicular vasculitis.11 Furthermore, there are 2 cases series describing testicular infarction secondary to vasculitis. In one series of 19 cases of testicular infarction with associated vasculitis, 14 showed polyarteritis nodosa features with transmural necrotizing inflammation of small-medium arteries.