Isolated tuberculous orchitis presented as epididymo-orchitis: An unusual presentation of tuberculosis

Abstract

Urogenital tuberculosis (UGTB) is almost 8%–15% of the extrapulmonary site of TB of all kinds, and epididymal involvement is rarer, counted only 28% of UGTB. Isolated tuberculous epididymitis (ITE), without the inclusion of prostate or clinical evidence of renal involvement, is an even more rare entity and is challenging to diagnose. However, isolated epididymis TB presented as a huge scrotal abscess with scrotal sack involvement is exceptionally uncommon. The symptoms of such ITE resemble the epididymo-orchitis or malignant tumor, which results in misdiagnosis or delay in diagnosis. A 32-year-young man, sexually inactive, was presented with a rapid, painless scrotal growing. There was no clinical evidence for TB. Clinical examination of the genitalia revealed an enlarged right tactical with intratesticular masses (abuses) and swollen spermatic cord along with inflamed epididymitis. The radiological and laboratory shows no evidence of TB with clear chest X-rays, normal blood, and urine analysis. There were no symptoms of Mycobacterium tuberculosis during the microdot enzyme immunoassay analysis. A repeated magnetic resonance imaging and ultrasonic investigations were performed that revealed findings suggesting a chronic inflammatory process with severe abscess involving the spasmatic cord and scrotal sack, which mislead the diagnosis of epididymo-orchitis. Later, the extensive formation of superficial abscess breaches the scrotal sack. A pathological investigation of excretion and intrascrotal tissues established the diagnosis of ITE. The patient was kept on anti TB treatment medications for 12 months due to delay in diagnosis (12 weeks), continuous discharge, and severe involvement of epididymitis along with a scrotal sack and spermatic cord and had a remarkable recovery. The delayed diagnosis of ITE could lead the severe complication, which could result in surgical intervention or an orchiectomy. The first line of treatment should be the pharmacological approach for cases of epididymis TB, and surgery should be the 2 nd option. A surgical procedure should be considered only in cases where the diagnosis is not established or when there is a strong clinical indication such as abscesses, cutaneous fistulas, or extensive involvement of the epididymis and testis.

Unilateral Testicular infarction a very rare complication of genitourinary tuberculosis: a case report and literature review

“…A study conducted in a single teaching hospital in Ethiopia reported GUTB as the fourth most common form of EPTB, following lymph node, abdominal, and pleural involvement (8). Its involvement is rare, attributes for 8-15% of all EPTB cases (7,9). Concomitant active PTB or history of previous PTB might be evident in approximately 56-87% of patients (10).…”

“…Pathological examination and culture with isolation of mycobacteria are the gold standard con rmatory tests for TB diagnosis. The specimen to be tested was acquired either through ne-needle aspiration or biopsy ( FNAC/B), or through surgical biopsy (7). FNAC can provide a histological diagnosis when a clinical and radiological suspicion of malignancy is unlikely.…”

“…Tuberculosis affecting testes is extremely rare, accounting for only 3% of male genital TB (7,12,14). Testicular involvement is typically secondary to TB epididymitis (6).…”

“…Both urinary and genital organs will be involved in half of the cases, but isolated diseases of the genital organs are rare (5). The kidney is the most common site of GUTB with devastating morbidity, whereas male genital TB is a unique subset, with the epididymis and prostate being the most commonly affected genital organs (7). Genital TB other than TB epididymitis is rare, and few reports are available to guide its diagnosis and suggest its management.…”

Testicular tuberculosis

“…Juliana Garcia Alves da Trindade [1]  , Ana Caroline Siquara-de-Sousa [2]  and Diogo Goulart Corrêa [1] …”