Chronic epididymo-orchitis and scrotal ulcers

Abstract

Extrapulmonary tuberculosis (TB) still presents a diagnostic and therapeutic challenge. Genitourinary TB constitutes about 20% of the extrapulmonary cases in regions where TB is endemic. Tuberculous infection of epididymis and testis is difficult to differentiate clinically from pyogenic infection, tumour or infarction. High-resolution sonography is currently the best readily available technique for imaging the scrotum and its contents, and accurate differentiation is important for proper diagnosis and treatment. The authors are presenting a unique case of chronic epididymo-orchitis with scrotal ulcers.

Nonhealing scrotal ulceration—an unusual manifestation of TB epididymo‐orchitis: case report and review of literature

“…Although cases of tuberculous chronic epididymo‐orchitis have been reported, the association of scrotal ulcers is a rare phenomenon, and to the author's knowledge, only one previous report has documented a similar clinical picture . However, in our patient, there were no constitutional symptoms unlike in the previously reported case.…”

“…This patient also had no previous history or contact of TB, and his chest X‐ray was normal. A previous case report which reported a similar clinical presentation also did not exhibit evidence of previous pulmonary TB .…”

“…In 2014, the prevalence of bacteriologically confirmed TB was 531 (421–655) per 100,000 population; the prevalence of clinically diagnosed TB (i.e., smear‐negative and culture‐negative TB, including all extrapulmonary cases) was 116 (91–143) per 100,000 population; the prevalence of extrapulmonary TB was 58 (43–75) per 100,000 population . Genitourinary tuberculosis is the second most common type of extrapulmonary tuberculosis and constitutes about 15–20% of all extrapulmonary tuberculosis . Although hematogenous spread from pulmonary TB is thought to be the source of genitourinary TB, about 30–50% of genital TB had no associated pulmonary TB .…”

“…Extrapulmonary tuberculosis (TB) though rare in the Western setting is quite prevalent in South Asia. Genitourinary TB accounts for 15–20% of all extrapulmonary cases of TB . The clinical features of genitourinary TB are not always discernible from other pyogenic infections and inflammatory disorders in the first instance.…”

Lichen scrofulosorum

“…The most common variants seen were scrofuloderma (36.5%), lupus vulgaris (31%), tuberculosis verruca cutis (12.9%), LS (11.4%), papulonecrotic tuberculids (3.8%), erythema nodosum (2.2%) and erythema induratum of Bazin (1.5%). Cutaneous tuberculosis may also be a direct manifestation of underlying tuberculosis as seen in the case reported by Al Zayyani et al ,6 in which chronic tuberculous epididymo-orchitis presented as scrotal ulcers. Among the three tuberculids, the incidence of LS was found to be lowest (2%) in a large study conducted in Hong Kong 7.…”