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Objectives Lupus orchitis associated with antiphospholipid syndrome (APS) is a rare condition that involves inflammation of the testicles due to systemic lupus erythematosus (SLE), often exacerbated by blood clotting caused by APS. Orchitis in SLE can result from vasculitis, and when APS is also present, thrombosis in the small blood vessels of the testicles can lead to ischemia and pain. This could be misdiagnosed as testicular torsion.Methods This is a case report of a 41 yo Male patient with h/o SLE and APS who presented with bilateral testicular pain. His SLE/APS diagnosis was in 2010, based on +ANA, +anti-dsDNA, persistent positive Lupus Anticoagulant, inflammatory arthritis, myocarditis, myocardial infarction and unprovoked DVT. At the time of presentation in 2014, he was on hydroxychloroquine, methotrexate and coumadin with a therapeutic INR. His testicular Doppler ultrasound was suggestive of testicular vasculitis based on ischemic changes. Interestingly, he had a history of testicular pain back in 2010, leading to a diagnosis of testicular torsion s/p bilateral orchiopexy.Results He was admitted with severe testicular pain, and with a diagnosis of testicular vasculitis, was started on high-dose steroids with complete immediate resolution of the pain. We added Rituximab 1 gram every 2 weeks x 2 doses, which allowed a fast taper of steroids without any recurrence of the testicular vasculitis.Conclusions Lupus orchitis is a rare manifestation of systemic lupus erythematosus (SLE) that can cause acute, severe testicular pain, mimicking a urological emergency like testicular torsion. Because of its rarity, it may be misdiagnosed initially, leading to potential complications if not treated correctly.While specific studies on using rituximab for lupus orchitis are lacking, the drug has been used as an off-label treatment for severe or refractory systemic lupus erythematosus (SLE) manifestations.Here I report a case of lupus orchitis, successfully treated with rituximab as steroid steroid-sparing agent with no flare up to this day.