case_images: PMC5735612_01
case_images: Evaluation of skin biopsy, renal biopsy, and orchiectomy specimens from the 51-year-old man. (a) Hematoxylin and eosin stained section revealed surface ulceration in the skin. (b) IgA immunofluorescence was positive in epidermis and vessels of dermis. (c) Hematoxylin and eosin stained section revealed mesangial expansion with focal neutrophil aggregation in the glomerulus. (d) IgA immunofluorescence was positive mainly in the mesangium and some along the glomerular capillary loops. (magnifications x400 in (a)-(d)). (e) A low power view (x40) revealed the unremarkable vas deferens at the right lower corner and necrosis and abscess in the testicular parenchyma at the left upper corner. (f) Vasculitis was seen in multiple small arteries of spermatic cord at medium power view (x200). (g) High power view (x400) revealed organizing thrombus in a small artery causing nearly total occlusion of the vessel in the spermatic cord. (h) IgA immunofluorescence (x200) was positive (green granular staining) at the endothelium of multiple inflamed small arteries. Hematoxylin and eosin stains were performed in (e)-(g).
case_images: CRIN2017-9437965.001.jpg
case_images: PMC5735612_01_CRIN2017-9437965.001.jpg
case_images: fig1
case_images: Immunofluorescence was positive for IgA, IgM, and C3 in the vessel wall of the superficial dermis, consistent with IgA-associated leukocytoclastic vasculitis (Figures 1(a) and 1(b)). The glomerular basement membrane showed no significant microscopic abnormality (Figure 1(c)). Immunofluorescence study showed 3+ positive granular IgA staining in the mesangial and peripheral loop of the glomeruli (Figure 1(d)). Testicular abscess was identified (Figure 1(e)). Spermatic cord margins from bilateral orchiectomy specimens were further analyzed to show diffuse vasculitis in small arteries with scattered organizing thrombi in some (Figures 1(f) and 1(g)). The immunofluorescent section revealed strongly positive IgA staining along the endothelium of inflamed small arteries (Figure 1(h)), confirming the IgA vasculitis of the spermatic cords as the cause of the testicular ischemic infarction.