睾丸膿瘍­­－結核病的肺外表現

陳子双¹、莊燿吉¹

¹高雄長庚紀念醫院 泌尿科

Testicular Abscess - An Extrapulmonary Manifestation of Tuberculosis

Tzu Shuang Chen¹, Yao Chi Chuang¹

¹Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taiwan

Introduction: Genitourinary tuberculosis (TB), caused by Mycobacterium tuberculosis infection, is the second common type of extrapulmonary TB. Testicular TB accounts for only 3% of genitourinary TB which brings the difficulty to differentiate from other bacterial infections, granulomatous infection, acute infarction and malignancies. We report a case of an 82-year-old patient presented with a unilateral painful scrotal mass and purulent discharge from ulcerated lesion in scrotal area.

Case presentation: An 82-year-old man presented with 3-week history of left painful testicular mass. Although he initially visited a family medicine clinic where left epididymitis-orchitis was impressed, the mass grew in size and he still felt much painful after empirical antibiotics therapy. Upon physical examination, an erythematous and tender testicular mass was palpable. Bedside sonogram revealed a left testicular hypoechoic lesion with irregular contour and increased blood flow. Based on image examination, left orchitis with abscess formation was suspected and left inguinal orchiectomy was performed. Pathological findings revealed acute and chronic inflammatory cell infiltration with associated multinucleated giant cells and necrosis, diagnosed as necrotizing granulomatous inflammation. TB PCR test from the patient’s urine and the pathology specimen showed positive results, confirming the diagnosis of extrapulmonary (urinary tract) TB. Then anti-tuberculosis therapy was started for 6 months.

Conclusions: Despite the rarity of disease, testicular tuberculosis should be considered as a differential diagnosis in cases presenting with scrotal mass with abscess formation.