Comprehensive Management of Vasculitis and Suspected Polyarteritis Nodosa in an Older Patient.

Polyarteritis nodosa (PAN) is a rare autoimmune disease that affects medium-sized arteries and causes inflammation and damage to the blood vessel walls. Testicular pain is an uncommon symptom of PAN but can occur in rare cases. This specific symptom may be useful in diagnosing older patients with limited tissue access because of their vulnerability and high risk for biopsy complications. We report the case of a 78-year-old male patient with progressive fatigue and walking difficulty. After ruling out various forms of vasculitis and malignancy, we diagnosed the patient with PAN and intensively treated him with rituximab, which successfully cured his symptoms. This case report highlights the importance of intensively ruling out possible diagnoses mimicking vasculitis and treating vasculitis with a tentative diagnosis of PAN in older patients in rural hospitals. The progressive clinical course of vasculitis may devastate older patients' activities of daily living (ADLs). PAN may particularly affect older patients with possible hepatitis B infections. Thus, shared decision-making and prompt intensive treatment should be considered.

Post-COVID Pain Syndromes.

Although the number of SARS-CoV-2 new cases may be declining due to the implementation of the vaccine in the USA, there is a rising cohort of people with long-term effects from the virus. These long-term effects include loss of taste, heart palpitations, and chronic pain syndromes. In this commentary, we assess the current literature to appraise the knowledge of long-term COVID-19 effects related to long-term pain syndromes including testicular pain, headache, chronic pain, and chest pain.

Atypical presentation of COVID-19: Chronic bilateral testicular pain with lower extremity peripheral polyneuropathy, case report.

In context of COVID-19 pandemic, there has been different presentations of the infection. The relationship of testicular pain with COVID-19 has not been extensively studied. We present a 31 years old male, with SARS-COV-2 infection, repeatedly consulting for intermittent bilateral testicular pain. Two months later he reported acute loss sensibility and pain in extremities, being diagnosed with axonal fine fiber polyneuropathy. Although the presence of SARS-COV-2 in testis remains controversial, there is a potential orchiepididymitis risk due to viral binding to ACE2 receptor in testicle, and also could induce systemic vasculitis as another possible cause of orchitis.

Testicular Pain and Mesenteric Adenitis as an Atypical Presentation of COVID-19.

A 21-year-old Caucasian male with no past medical history presented to the emergency department with right lower quadrant pain radiating to the right testicle for two days. He reported an occasional dry cough that day but denied any fever or other infectious symptoms. The patient was afebrile with a normal physical examination. CT of the abdomen and pelvis showed prominent right lower quadrant lymphadenopathy. Viral panel for common respiratory pathogens returned negative. A nasopharyngeal swab for SARS-CoV-2 by Xpert® Xpress SARS-CoV-2 reverse transcriptase-polymerase chain reaction (Cepheid Inc., Sunnyvale, CA) was positive. The patient remained in quarantine for 14 days. He was reevaluated seven weeks later with spontaneous resolution of his abdominal pain and the continued absence of upper respiratory symptoms. A repeat CT scan seven weeks later showed persistent mesenteric lymphadenopathy. Repeat COVID-19 testing was not performed at this time. While the frequency of atypical presentation of COVID-19 remains unknown, healthcare providers must continue to remain vigilant and consider COVID-19 as a differential diagnosis in any patient presenting to the emergency department despite the lack of respiratory and gastrointestinal symptoms. Further research is warranted to examine the possibility of asymptomatic spread in asymptomatic patients with persistent radiologic findings and to assess whether repeat COVID-19 testing is warranted in such patients.