ANCA-associated vasculitis is a rare autoimmune disorder affecting small to medium-sized vessels, often targeting the respiratory tract and kidneys. Testicular involvement is rare and can resemble malignancy, leading to unnecessary surgery. A 36-year-old male presented with painful fingers, oral and nasal ulcers, and knee arthritis. Elevated proteinase 3 (PR3) antibodies confirmed PR3 ANCA-associated vasculitis. During hospitalization, patient developed testicular pain, and an ultrasound raised suspicion of malignancy. An inguinal orchidectomy was performed, revealing inflammation consistent with vasculitis, but no malignancy. Testicular involvement in ANCA vasculitis can mimic cancer, and increased awareness may help prevent unnecessary surgical procedures.