Epididymal Tuberculosis: A Diagnostic Challenge, Sonographic Findings, and Differential Diagnosis

Mahaveer, Jeevan; Weston, Michael; Wolstenhulme, Stephen

doi:10.1177/8756479317727503

Cited by 4 publications

(3 citation statements)

References 9 publications

(15 reference statements)

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“…Despite US being cheap, easy to perform, associated with minimal risk of radiation, and having remarkable reliability for assessing complications of epididymal TB, the examination has low specificity for the diagnosis of epididymal TB [ 17 ]. US is the gold standard for evaluating the scrotum, but not for epididymal TB [ 20 ]. Besides, renal US is necessary to evaluate the upper urinary tract for hydronephrosis frequently found in GUTB with prostate association [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

The challenges in diagnosing isolated epididymal tuberculosis (TB) in an adolescent male: a case report

Cesilia,

Nugraha,

Siregar

et al. 2024

BMC Urol

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Background Genitourinary tuberculosis (GUTB) is a common form of extrapulmonary TB (EPTB) in children. An example of GUTB is epididymal TB, which usually presents unspecific chronic clinical manifestations. Definitive diagnosis can be conducted based on bacteriologic confirmation and histopathologic results, but this is challenging due to the paucibacillary nature of EPTB. Therefore, we reported the challenges in diagnosing isolated epididymal TB in an adolescent male. Case presentation A 16-year-old male presented to respirology clinic with painful swelling of the left scrotum for 3 months before visiting to the hospital. The symptoms were associated with persistent coughing for 2 months, and physical examination of the left scrotum showed swelling accompanied by cardinal signs. A palpable hard mass was found on the left scrotum, with firm borders, measuring 7 × 4 cm. Laboratory examination and tumor markers were within normal limits, although leukocyturia was found, and the urine culture was negative. Genital ultrasound (US) showed epididymitis sinistra with septal hydrocele, while magnetic resonance imaging (MRI) indicated inhomogeneous left epididymitis with bilateral inguinal lymph node enlargement. Although TB evaluation presented a negative purified protein derivative (PPD) test and bacteriologic examination, chest X-ray (CXR) showed perihilar lymphadenopathy. Based on the clinical and radiologic results suggesting TB, the patient was diagnosed with isolated epididymal TB and received quadruple antituberculosis therapy (ATT) for 6 months. After treatment, the left testicle size started to shrink and was equal to the right testicle, also, there were no signs of inflammation, the body weight increased by 5 kg, and cough disappeared. Sperm analysis at the end of treatment indicated teratozoospermia, which was subsequently treated by the urologic surgery department. Conclusions Biopsy and bacteriologic confirmation for TB epididymitis were challenging to perform in the clinical setting. Epididymal TB should be considered in adolescent males with complaints of chronic scrotal swelling and pain. Clinical judgment based on history taking, physical examination, and radiologic features supporting TB features could be helpful in accurate and fast diagnosis for favorable outcome.

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Section: Discussionmentioning

confidence: 99%

The challenges in diagnosing isolated epididymal tuberculosis (TB) in an adolescent male: a case report

Cesilia,

Nugraha,

Siregar

et al. 2024

BMC Urol

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“…18,19 Even though the US is a cheap, easy, minimal radiation, reproducible examination to help assess complications of epididymitis TB, such as stula or abscess formation, the features of epididymitis TB are not speci c. 17 US is the gold standard for evaluating the scrotum but is still not considered the gold standard diagnostic tool for tuberculous epididymitis. 20 Besides, renal US is necessary to evaluate the upper urinary tract for hydronephrosis, which often occurs in UGTB with prostate involvement. 12 On MRI, TB lesions may show a T2 hypointense picture, similar to TB lesions elsewhere.…”

Section: Discussionmentioning

confidence: 99%

Isolated Epididymitis Tuberculosis in an Adolescent Male: When Foresight Clinical Decisions Determine the Right Diagnosis

Cesilia,

Nugraha,

Siregar

et al. 2023

Preprint

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Background: Urogenital tuberculosis (UGTB) is one of the common extrapulmonary TB in children. One form of UGTB is epididymitis TB, which is reported rarely in children. Epididymitis TB presented with unspecific chronic clinical manifestation and definitive diagnosis made by bacteriological confirmation due to paucibacillary and histopathology findings. Case presentation: A 16-year-old boy had been admitted to the hospital due to painful swelling of the left scrotum in the last three month. Persistent coughing for 2 months was reported. Physical examination of the left scrotum showed swelling accompanied by cardinal signs. Palpable hard mass on the left scrotum, firm borders, pain, measuring 7x4 cm. Laboratory examination was within normal limits, tumor markers (AFP, CEA, LDH) within normal limits, and routine urinalysis showed leukocyturia. Genital ultrasound showed epididymitis sinistra with septal hydrocele. Genital MRI showed left epididymitis with bilateral inguinal lymph node enlargement. TB evaluation examination showed a PPD test of 0 mm and a negative bacteriologic examination, but CXR showed perihilar lymphadenopathy. The patient was diagnosed as isolated TB lymphadenitis and received quadruple ATT for two months, followed by RH for four months. After treatment, the size of the left testicle decreased and was equal to that of the right; no signs of inflammation were found, weight increased by 5 kg, and cough disappeared. However, sperm analysis at the end of treatment showed teratozoospermia. The patient is currently being treated for teratozoospermia by urologic surgery colleagues. Conclusions: Biopsy and culture testing for TB epididymitis confirmation are difficult to perform in the clinical setting. TB epididymitis should be considered in adolescent boys with complaints of chronic scrotal swelling and pain. Clinical judgment based on history taking, physical examination, and radiologic features supporting the picture of tuberculosis is helpful to diagnose correctly and quickly for a favorable outcome.

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“…CT or MRI have little value in diagnosing epididymal TB; however, they are important to diagnose tuberculosis in lung and kidney and provide support for the diagnosis of epididymal tuberculosis. 11,16 Ultrasonography of Tb epididymitis is characterized by enlarged, heterogeneous and hypoechoic lesion in the body and tail, associated with hypoechoic testicular lesions or discharging sinuse. 10 The combination of clinical, radiological, histopathological and microbiological finding all play an important role in the diagnosis of TBEO.…”

Section: Discussionmentioning

confidence: 99%

Isolated epididymal tuberculosis: case report and review of literature

Assefa

Asfaw

2022

Int J Sci Rep

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<p>Ethiopia is one of the countries with high burden of pulmonary tuberculosis and the number of cases of extra pulmonary is increasing. However, diagnostic evidence to initiate anti-tuberculosis treatment among extra pulmonary tuberculosis (EPTB) cases is not well known. We presented here a case of isolated tuberculosis epididymitis with scrotal sinus after developing nonspecific testicular symptoms for more than 2 months and review the literature. Tuberculous epididymitis is a form of urogenital tuberculosis that is particularly rare and has the same clinical manifestation that mimics other more common infectious causes of epididymitis, leading to delay in diagnosis. So, one should maintain a high-index of suspicion to accurately diagnose tuberculous epididymitis in individuals presenting with suggestive signs and symptoms.</p>

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Epididymal Tuberculosis: A Diagnostic Challenge, Sonographic Findings, and Differential Diagnosis

Cited by 4 publications

References 9 publications

The challenges in diagnosing isolated epididymal tuberculosis (TB) in an adolescent male: a case report

The challenges in diagnosing isolated epididymal tuberculosis (TB) in an adolescent male: a case report

Isolated Epididymitis Tuberculosis in an Adolescent Male: When Foresight Clinical Decisions Determine the Right Diagnosis

Isolated epididymal tuberculosis: case report and review of literature

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