Unilateral testicular abscess: A rare manifestation of late-stage reactivation of extrapulmonary tuberculosis

Abstract

Genitourinary tuberculosis accounts for 8–15 % of cases of extrapulmonary tuberculosis, with the testis being an infrequent site of involvement, seen in 3 % of individuals with genital tuberculosis. Testicular tuberculosis often presents with symptoms that mimic those of other testicular conditions, including neoplasms, infections and testicular torsion. We report the case of a 51-year-old male with a history of tuberculosis 11 years prior, who presented with left testicular pain, swelling, and an ulcer. Initial ultrasound findings suggested were unclear and only the histopathological examination ultimately confirmed a diagnosis of testicular tuberculosis. The patient was treated with complete clinical resolution.

Highlights

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Testicular tuberculosis is a rare manifestation of genital tuberculosis.
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Ultrasound is a valuable diagnostic tool for evaluating testicular pathology.
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Early diagnosis and appropriate anti-tuberculosis therapy can lead to favorable.

1 Introduction

Testicular tuberculosis (TT) is a rare manifestation of extrapulmonary tuberculosis, affecting approximately 3 % of patients with genital tuberculosis. It is often associated with the involvement of other genital structures such as the epididymis, prostate, and seminal vesicles. The diagnosis of TT is challenging, as its clinical presentation often mimics other testicular conditions such as tumors, infections, and torsion. Although ultrasound is a useful imaging modality in diagnosing testicular tuberculosis and testicular tumors, it cannot reliably differentiate between the two. Definitive diagnosis requires histological confirmation, typically through fine needle aspiration or biopsy.

2 Case presentation

A 51-year-old male, a bricklayer by profession, presented to our clinic with complaints of left testicular pain, swelling, and an ulcer with purulent secretion over the last two weeks. The patient had a remote medical history, including chest pain and hemoptysis 11 years prior, at which time a CT scan revealed excavated lesions in the right lung apex, suspicious of tuberculosis (TB). He had not received any anti-TB therapy at that time.

On physical examination, the left scrotum was significantly enlarged, with a palpable mass occupying the entire scrotal sac. The mass altered the intrascrotal structure, and there was an ulceration over the scrotal skin, secreting purulent material. The right testis appeared normal on examination. The patient denied fever, systemic symptoms, or trauma.

The patient was referred for further imaging, including ultrasound (US), to assess the scrotal mass and guide further management. US of the left testis showed a dysmorphic testicle with irregular, blurred contours ( Figure_1 ). The testis was reduced in size, and its structure was non-homogeneous, with areas of hypoechogenicity suggesting fluid or abscess formation. These findings raised concern for a testicular abscess. Additionally, there was evidence of a non-homogeneous mass extending from the testis to the scrotal skin, indicating possible extension of the infectious process ( Figure _2 ). Color Doppler US revealed reduced vascularity within the testicular parenchyma, further suggesting an abscess or significant inflammatory process rather than a malignancy. The ipsilateral epididymis was not clearly identifiable, which is consistent with an advanced inflammatory process affecting the testis. The right testis appeared normal, with no abnormal findings on ultrasound.