Isolated tuberculous epididymo-orchitis: an unusual presentation of tuberculosis

Abstract

Isolated epididymo-orchitis is an unusual presentation of tuberculosis. A case of bilateral epididymitis and right-sided orchitis with scrotal involvement in a 38-year-old male patient is presented. Strong clinical suspicion of tuberculous etiology was confirmed by appropriate investigations of epididymal biopsy. The patient improved clinically with antitubercular therapy.

Isolated Testicular Tuberculosis: A Dubious Facade

“…[3,4,5,6,7] Testicular tuberculosis usually affects ages from 30-50 years, but it creates a diagnostic impasse when it presents as a painless, diffuse testicular swelling in absence of fever, burning urination or infertility and clinical examination revealing non-tender indurated testis thus mimicking a testicular neoplasm. [5,6,7,8] Testicular neoplasms are hypoechoic on Ultrasonogram and show hypointense enhancement on T1W MRI images. [5] As the findings of Ultrasonogram are non-significant and the rarity in incidence of isolated testicular tuberculosis; any testicular swelling presenting with atypical features should be treated as testicular tumour (with orchidectomy) unless proven otherwise.…”

“…[5] Histopathology confirms the diagnosis of testicular tuberculosis by presence of granulomas consisting of caseous necrosis, plasma cell infiltration, epithelioid cells, Langhans Giant cells and ATT should be started. [8] …”

Tuberculous epididymo-orchitis mimicking a testicular tumour: a case report

“…8 TB epididymo-orchitis is a common form of GUTB but when it is isolated, it may mimic testicular tumour. 3 Testicular tumour is rare among blacks and requires surgical removal with adjuvant chemoradiotherapy unlike testicular TB. Reported cases with clinical diagnosis of testicular tumours that were found to be testicular tuberculosis after surgery sometimes have TB affecting other associated organs like the seminal vesicle, prostate or kidneys.…”

“…2 Isolated instances of tuberculous epididymitis or epididymo-orchitis is rare but when it occurs, a comprehensive assessment of the patient is mandatory. 3 Recent surge in the prevalence of TB worldwide linked to human immunodeficiency virus (HIV) pandemic has resulted in a concomitant increase in extrapulmonary TB of which GUTB accounts for up to 20% in endemic areas. 4 Tuberculous epididymo-orchitis may mimic testicular tumours particularly in apparently healthy patients with no other clinical symptoms or signs.…”

Extra Pulmonary Tuberculosis: An Observational Study in a Teritiary Care Hospital, Mysore

“…TB epididymo-orchitis is a common form of Genitourinary TB but when it is isolated, it may mimic testicular tumor. 16 Confirmation of EPTB is challenging for a number of reasons: the difficulty to obtain an adequate sample; the processing of the sample for various diagnostic tests resulting in non-uniform distribution of microorganisms; the pauci-bacillary nature of the specimens; the presence of inhibitors that undermine the performance of nucleic acid amplification-based techniques; and the lack of an efficient sample processing technique universally applicable on all types of extra pulmonary samples. Diagnoses of EPTB without microbiological confirmation may result in overdiagnosis.…”