Unusual presentation of tuberculosis.

swelling of both ankle joints the next day. He complained of limping. At 16-00 hours on 15 September he developed sudden pain in the left side of the scrotum, which rapidly increased in severity. The purpuric rash now involved both lower extremities, the perineum, the suprapubic region, and both buttocks. The patient was the second of three boys in the family. He was born a: full term, delivered normally, and the birth weight was 3-5 kg. There was no family history of any bleeding diathesis nor was there a history of bleeding or a similar episode of anaphylactoid purpura in this child. The child was in severe pain from the obviously inflamed swelling on the left side of the scrotum. He was afebrile. A typical uticarial and purpuric rash with the distribution described together with arthralgia of both ankles suggested a diagnosis of Henoch-Schonlein syndrome. There were many purpuric spots on the scrotum particularly on the left side, which was swollen and looked inflamed. Both testes were palpable. The left testis was drawn-up and tense, felt enlarged, and was very tender. The right testis was normal. A diagnosis of Henoch-Schonlein syndrome with vasculitis of the left testis was made. In view of the clinical findings torsion of the left testis was suspected, and we decided to explore the scrotum. At operation all the layers of the left testis were haemorrhagic and oedz-matous. It was considerably enlarged, blue, and congested due to the obvious torsion. The cyst of Morgagni was congested and haemorrhagic. Vasculitis was also present. The testis was untwisted and its colour returned to normal in a few minutes. It was then fixed in the usual manner. The right testis was not explored. The patient was well postoperatively; the oedema in the scrotum disappeared and there was no increase in the extent of the pur-puric rash or in the arthralgia. He remained well until 22 Septem-ber 1973 when he had bloody diarrhoea with melaena and vomiting. The urine contained a few red blood cells but there was no other evidence of glomerulonephritis. He complained of severe pain in the abdomen. He responded to treatment and his symptoms quickly improved. On 26 September 1973 the haemoglobin was 12 g/100 ml; W.B.C., 11,600/mm3; platelets 315,000/mm3. He was symptomless and the urine and stools were negative for blood.