Answer of October 2024
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Clinical History:
M/74. 1st admitted for right scrotal abscess I&D. Discharged after I&D with a course of ciprofloxacin, plan surgical follow-up in 9 months. Readmitted just before follow-up, no fever, painless gross scrotal swelling.
USG Scrotum
Right epididymis
MRI L-spine (Axial T1 FS + C)
DIAGNOSIS:
Tuberculous infection
DISCUSSION:
US showing the left testis had a heterogeneous parenchymal echo, and multiple hypo-echo and ill-defined areas. In the color Doppler ultrasound, the left testicle was hyperemic. There is right epididymitis. There are bilateral psoas abscesses on MRI.
The patient undergone orchidectomy, PCR for M. TB was positive. He was put on anti-TB treatment.
Testicular tuberculosis (TB) is a rare form of genitourinary TB. It is usually presented as painful or painless testicular swelling with or without scrotal ulceration or discharging sinus. Infertility may occur. Epididymal involvement is usually seen in testicular TB. In most cases, genital TB is associated with TB involvement of kidneys or lower urinary tract. Ultrasound (USG) and USG-guided fine needle aspiration cytology of testicular swelling confirm the diagnosis. Anti-TB chemotherapy is the mainstay of treatment to ensure the complete resolution of the lesion. However, in very few cases, orchidectomy is required for both diagnosis and treatment.
Reference:
1. A rare case of isolated testicular tuberculosis and review of literature. J Family Med Prim Care. 2016 Apr-Jun; 5(2): 468–470. doi: 10.4103/2249-4863.192334
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