Testicular Vasculitis Associated with Sepsis Due to Viruses and Bacteria

Septic vasculitis is an inflammation of small caliber blood vessels caused by the direct or indirect action of pathogens in the context of sepsis. The aetiology is very varied with possible pathogens including bacteria, viruses, fungi, protozoa, yeasts, helminths, and algae. The testis, like other organs, can be affected by four mechanisms: septic embolism, direct invasion of the vascular wall by microorganisms, immune complex-mediated vasculitis, and disseminated intravascular coagulation. Several mechanisms can be observed in the same patient. The type of vasculitis, extrapolating from the vessel characteristics observed in the skin, has been defined as “a variant of neutrophilic vasculitis associated with septicemia produced by various organisms”. The histological findings of septic vasculopathy have a very broad spectrum ranging from thrombotic vasculopathy to neutrophilic vasculitis. The histopathology of septic vasculopathy has some distinguishing features that distinguish it from that of classic neutrophilic small vessel vasculitis: preferential arteriolar involvement, few signs of leukocytoclasia, presence of luminal thrombi and, frequently, fibrinoid necrosis or bacterial invasion of the vessel wall. Most vasculitis are caused by a type III hypersensitivity reaction secondary to the formation of immunocomplexes that are deposited in the vascular wall. Consequently, complement is activated and triggers the cascade process that generates the inflammatory infiltration of the vessel wall. Due to their peculiarity, two situations have been included in this chapter: vasculitis due to cytomegalovirus and vasculitis due to Tropheryma whipplei. Both cases were autopsy findings.