病例報告-睪丸結核

馬來西亞 亞羅士打 仁愛專科醫藥中心 泌尿外科

Division of Urology, Putra Medical Centre, Alor Setar, Malaysia

 

Purpose: We reported a case of testicular tuberculosis whom received surgical intervention in our hospital.

Case Presentation: A 31 year old male with chief complaints of right scrotum pain and swelling since Jan 2016. He ever visited local clinic but in vain. He turned up to our urology department on 4^th Feb 2016. He was admitted for IV antibiotic under the impression of right epididymo-orchitis (diagnosed by sonography). Lab test was done with not significant except urine test shown: Bac +. He was discharged after 3 days of treatment with oral antibiotic then. The condition flared up and he was readmitted on 17^th March 2016 with repeated sono and pelvic CT with enhancement. Result reveled: right epididymo-orchitis with reactive hydrocele. After discharge, the symptoms of pain and swelling persisted with fever sometimes. He was planed to do incision, drainage with possibility of right orchidectomy under the impression of right testicular abscess on April. Unfortunately, he was loss follow up. Finally, he was admitted on 3^rd June 2016 and received operation: right orchidectomy under SA. The pathological report was right testicular tuberculosis with Ziehi-Neelsen acid fast bacilli (+) with micro findings: epithelioid cell granulomas, central necrosis with Langhans type giant cell in both epidydimis and testis. Tracing back family history, his mother had Pulmonary TB with complete treatment course. After discussion, he was referred to tertiary hospital for TB medication.  

Conclusion: Pulmonary tuberculosis is most common type, accounting for about 70% of cases. Sometimes, pulmonary TB will spread, though this usually happens only in immune-suppressed patients and young children. ¹ The incidence of genital TB (included prostate gland, seminal vesicle, and testis) in men was reported to account for 0.43–15% of extrapulmonary TB.² Dissemination of TB to the testis may result in secondary infection of epididymis. In many of these cases, there is associated tuberculosis prostatitis and seminal vesiculitis, and it is believed that epididymitis usually represents a secondary spread from these other involvements of the genital tract. Our male patient presented with intractable and relapse of chronic scrotum infection symptoms and sign although receiving several course of antibiotic treatment. Thus we should consider to do further surgical intervention under the consideration of malignancy or other course of chronic infection such as tuberculosis. Anti TB drug is compulsory after the diagnosis is confirmed.

1. A.I. Shugaba, A.M. Rabiu, C. Uzokwe, R.M. Matthew. Tuberculosis of the Testis: A Case Report. Clin Med Insights Case Rep. 2012; 5: 169–172.

2. Ing-Kit Lee, Wen-Chou Yang, Jien-Wei Liu. Scrotal Tuberculosis in Adult Patients: A 10-Year Clinical Experience. Am J Trop Med Hyg October 2007 vol. 77 no. 4714-718.