JOON HA WOO DO* CHRISTINA JEE AH RHEE CHRISTIAN CASTANEDA AND RAMMOHAN GUMPENI INTRODUCTION: Extra-pulmonary TB represents 10-15% of tuberculosis infections. Urogenital tuberculosis is a small and rare subset of these infections [1]. On the other hand, disseminated Mycobacterium bovis infections have been reported in the setting of intravesical Bacillus Calmette-Guérin (BCG) treatments [2,3]. We present a patient with symptoms of epididymo-orchitis with cavitary lung disease on imaging, whose suspicion was high for disseminated M. bovis based on previous BCG treatments, but was found to have necrotizing scrotal granulomas, positive for M. tuberculosis (MTB) with PCR.CASE PRESENTATION: A 72-year-old man with a past medical history of chronic obstructive pulmonary disease and urothelial cancer presented with symptoms of epididymitis after failed outpatient treatment. He completed his intravesical BCG treatments for urothelial cancer 1 week ago. CT of the pelvis was notable for left scrotal collection consistent with an abscess, with concerns for a necrotizing infection. CT Lung showed a thick-walled cavitary lesion in the right lower lobe, suspicious for malignancy. He underwent surgical exploration of the scrotum, which revealed his left scrotum infiltrated with pockets of infected tissue. He subsequently underwent left orchiectomy without complication.
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