Systemic Wegener's granulomatosis involving the testes

We report a patient with biopsy proven ANCA positive Wegener's granulomatosis (WG) of the lung who also presented with testicular pain. Ultrasound of the scrotum showed bilateral intra testicular masses with hypoechoic densities. Testicular tumour markers were negative. The patient was treated empirically for possible orchitis with antibiotics with no improvement in symptoms. The patient also received treatment with immunosuppressants and steroids for Wegener's granulomatosis with improvement in his overall symptoms. Since he refused a testicular biopsy, a repeat sonogram of the scrotum was obtained after four months. The scrotal sonogram showed complete resolution of the hypo echoic densities suggesting probable testicular involvement with Wegener's granulomatosis which responded to immunosuppressive treatment.