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A rare case of methamphetamine induced testicular ischemia, a 35-year-old man with clinical and sonographic features of left epididymitis. However, Ultrasound incidentally showed a lack of vascularity of the right testicle despite being asymptomatic on the right hemi-scrotum. He was a known intravenous methamphetamine user, admitting his last injection was 4 h prior to his presentation.The left epididymitis was treated with antibiotics, analgesia and scrotal support, while right testicle was treated conservatively with serial ultrasounds. Repeat ultrasound in 20 h confirmed the return of normal vascularity of the right testicle confirming methamphetamine induced testicular ischemia, no surgical intervention needed.