A Rare Case of Sarcoidosis With Urologic Symptoms As the Presenting Feature

Abstract

Sarcoidosis is a multisystem idiopathic disease that can affect virtually any organ of the human body. However, genitourinary tract involvement is rare. We describe the case of a 33-year-old man with post-coital right scrotal pain. Scrotal ultrasound showed two vascularized nodular lesions in the right testicle and one in the left. A thoracic and abdominopelvic computed tomography scan showed micronodular infiltrate in the liver, spleen, lungs, and millimetric retroperitoneal and iliac lymph nodes. Levels of alpha-fetoprotein and human chorionic gonadotropin beta were normal. On positron emission tomography, the previously documented micronodular infiltrate exhibited features suggestive of an inflammatory etiology. The aspiration cytology of an iliac ganglion was described as normal, with no malignant cells. A liver biopsy revealed non-caseating epithelioid granulomas characteristic of granulomatous hepatitis. After exclusion of other causes of granulomatous inflammation, conjugation of clinical and histological features led us to the diagnosis of sarcoidosis with pulmonary, hepatic, splenic, and genitourinary involvement. This clinical report describes one of the rare occasions when the reproductive tract is affected by sarcoidosis and is the first organ to present signs of involvement by the disease, which reinforces the importance of considering sarcoidosis in the differential diagnosis of urologic conditions. The diagnosis of testicular sarcoidosis is challenging and the issue of its impact on fertility is particularly important.

Unnecessary orchiectomy due to atypical sarcoidosis manifesting as a unilateral scrotal mass: a case report and literature review

“…Primary sarcoidosis in the genitourinary tract is extremely rare, especially when it comes to the primary detection of the disease in this location. As a consequence, sarcoidosis is rarely considered as a possible cause of pathological findings in these unusual locations, putting patients at risk of unnecessary procedures and surgical interventions that can negatively impact their quality of life ( 3 , 4 , 8 , 10 , 11 ).…”

“…It may be a hernia, an abscess, a localised form of tuberculosis or syphilis, or even a malignant tumour (a primary or secondary site, or even a manifestation of lymphoma). Sarcoidosis is typically diagnosed by exclusion ( 6 , 11 , 21 , 28 , 29 ).…”

“…However, even in the case of benign lesions, their values can be false positive. At the same time, if these oncomarkers are negative, a malignant lymphoma differential diagnosis is still not ruled out ( 3 , 7 , 11 , 16 , 18 ).…”