Epididymo-orchitis with epididymal abscess in a patient with disseminated tuberculosis

Abstract

Abstract Tuberculosis remains a global health concern, and while primarily affecting the lungs, extrapulmonary manifestations like genitourinary tubercular epididymitis are rare and diagnostically challenging. Accurate differentiation is crucial for appropriate treatment. This case study presents a 34-year-old male with left scrotal swelling, backache, and fever, highlighting the importance of considering tuberculosis in genitourinary conditions. High-resolution sonography revealed an edematous left testis with increased vascularity and hypoechoic nodules. Further imaging, including high-resolution computed tomography thorax and contrast-enhanced magnetic resonance imaging Dorso-lumbar spine, confirmed disseminated tuberculosis. Despite negative urine culture, aspiration cytology from the epididymal collection indicated tubercular etiology. Urogenital tuberculosis, especially isolated epididymal involvement without renal effects, presents diagnostic challenges, often occurring in immunocompromised patients. The case underscores the role of clinical, biochemical, and radiological evidence in establishing a correct diagnosis. High-resolution ultrasonography plays a crucial role in diagnosing scrotal pathologies, and when accompanied by an epididymal collection, further diagnostic steps involving biochemical parameters and aspiration followed by cytoanalysis and culture are essential. The diagnosis of tuberculous epididymitis can be confirmed through acid-fast bacilli (AFB) identification, positive AFB culture, or granulomas seen in a biopsy specimen in the right clinical context. Radiological imaging aids in detecting local and disseminated disease forms, including complications like hydrocele, testicular calcifications, scrotal abscesses, sinus tracks, and fistulous communications.