Isolated testicular tuberculosis is rare, often diagnosed incidentally during histopathological examination due to its asymptomatic nature. We present a case of a 35-year-old male with a left testicular mass mimicking malignancy. Despite normal tumor markers and negative imaging for pulmonary tuberculosis, left inguinal orchiectomy revealed testicular tuberculosis. Diagnostic challenges are compounded by the disease\'s rarity and atypical presentation. Genitourinary tuberculosis\'s diagnostic complexity underscores the need for heightened clinical suspicion, particularly in tuberculosis-endemic regions. While orchiectomy may be necessary, this case underscores the importance of considering tuberculosis in testicular masses. Early recognition facilitates appropriate management and underscores the importance of diagnostic vigilance.

UNASSIGNED: Tuberculosis is prevalent in African countries especially in sub-Saharan Africa where HIV/AIDS is common. While Testicular tuberculosis is uncommon in the young as well as the elderly, pulmonary tuberculosis is commonly observed in these populations. History, physical examination, scrotal ultrasonography, and fine needle biopsy are important in diagnosis of suspected cases of testicular tuberculosis. Anti-TB therapy is the mainstay of treatment to ensure complete resolution of the lesion. However, in a few cases, orchidectomy is required for both diagnosis and treatment. When treating testicular tuberculosis, it is crucial to do a thorough assessment and investigations to exclude testicular malignancy because tuberculosis can present similarly to a testicular tumor.
METHODS: We report a rare case of right sided isolated testicular tuberculosis in a 45-year-old male who came with right sided testicular pain and swelling. Blood workups and testicular tumor markers were all normal, scrotal ultrasound reported right heterogenous testicular mass with avascular areas of necrosis and septated fluid collections in the tunica vaginalis with features suggestive of testicular tumor. Right orchiectomy through inguinal approach was done, findings included testicular mass with pus pockets and caseous necrosis occupying the whole testis. Specimen was sent for histopathology which revealed chronic granulomatous inflammation, most likely tuberculosis, and ZN stain confirmed the diagnosis of testicular tuberculosis. In accordance with national TB guidelines, the patient had anti-TB medication for six months, and after 12-months serial follow-up, the patient had completely recovered.
UNASSIGNED: Genitourinary tuberculosis is the second most common form of extrapulmonary TB after lymph node tuberculosis. 0.5 % of genitourinary TB involves the testes; On the other hand, isolated testicular TB as presented in our patient, is extremely uncommon, thus may mimic other testicular conditions including testicular tumor, so the diagnosis is challenging. It is important to accurately diagnose testicular TB and differentiate it from other scrotal pathologies especially testicular malignancy as the management is totally different. Testicular tuberculosis is diagnosed by tissue Cytology using FNAC or after an orchidectomy. It requires early, regular, full course combined anti-tuberculosis treatment. The drug treatment method uses three to four anti-tuberculosis drugs for 6-9 months. Surgical treatment is necessary if there is no response to drug treatment or in cases of abscess formation.
CONCLUSIONS: Testicular TB is a curable disease, but its diagnosis remains challenging. It is often missed owing to its non- specific symptoms. Thus, testicular TB should be suspected in patients with a notion of contagion or history of tuberculosis. Some of the radiological features are highly suggestive of testicular TB. FNAB could prevent unnecessary orchidectomy. In our case, the presentation was typically mimicking a testicular cancer and the patient underwent trans inguinal orchiectomy, and histology and ZN stain confirmed the diagnosis followed by subsequent six-month anti TB therapy.

Testicular or epididymal tuberculosis is a rare form of extrapulmonary tuberculosis. Extrapulmonary tuberculosis of any form is very difficult to diagnose by microscopy because it is usually paucibacillary. Therefore, molecular methods play a major role in the diagnosis of extrapulmonary tuberculosis. We present a rare case of unilateral testicular tuberculosis in a 23-year-old immunocompetent patient with no history of contact with a known tuberculosis case. He presented to us with swelling on his testis for one month and a discharging sinus in the left testis for 15 days, along with an intermittent fever for a week. A pus swab from the discharging sinus of the testis was sent to microbiology, where a cartridge-based nucleic acid amplification test (CBNAAT) was done, which detected Mycobacterium tuberculosis complex (MTBC), but resistance to rifampicin was not detected. A line probe assay was also done on the sample for first-line drugs, and no resistance was detected for rifampicin or isoniazid. The patient was started on first-line drugs in the intensive phase, and after the completion of two months of treatment, the patient\'s discharge stopped and he showed clinical improvement. Being a young patient, if he had not been diagnosed and treated as early as possible, it could have led to infertility. This again emphasizes the importance of molecular methods for the diagnosis of extrapulmonary tuberculosis.

Tuberculosis is especially common in African countries where HIV is common. Although pulmonary tuberculosis is generally seen, testicular tuberculosis can rarely be seen in young men. Especially in African countries, it is not possible to study acid-resistant bacilli, polymerase-chain reaction and culture due to financial impossibility. For this reason, history, physical examination, scrotal ultrasonography and fine needle biopsy help in diagnosis in suspected cases of testicular tuberculosis. Cure is possible with six months of treatment.

We describe the case of a 41-year-old Hispanic male, inconsistently adherent to visits and workup due to socioeconomic challenges, who presented with a right testicular mass. Because of the overriding concern that this was malignant, he underwent a right orchiectomy. Pathology revealed granulomatous disease with no evidence of malignancy. No specific diagnosis was made histologically or microbiologically on primary laboratory investigation. Six months later, he developed swelling of the left testicle and was subsequently seen in consultation at the Infectious Disease Clinic Kern Medical. An extensive evaluation for granulomatous inflammation was undertaken without a positive result. A clinical diagnosis of tuberculous epididymal orchitis was made and the patient was initiated on standard 4-drug antituberculous therapy. There was a gradual resolution of pain and swelling. After 6 months of therapy, there was no evidence of residual disease. The patient remains asymptomatic after 8 months of post-therapy follow-up.

BACKGROUND: Disseminated tuberculosis (TB) or miliary TB is defined as lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli, which may then affect virtually any organ system. The multiple organ involvement in disseminated TB can mimic metastatic cancer and can make the diagnosis challenging. False negatives are common therefore repeating microbiologic and histologic samples is essential.
METHODS: We report the case of a young immunocompetent patient presenting with multiple atypical extra-pulmonary TB involvement. The patient presented with pulmonary, pleural, bilateral testicular and multiple bone involvement including calcanerium abscesses. These lesions were initially described as metastasis by the radiologist. Therefore lymphoma and metastatic testicular cancer as well as TB were high on the differential in this young foreign-born male. Pleural, broncho-alveolar lavage, bone marrow and cerebrospinal fluid acid-fast bacilli smear and microbiologic culture were all negative. However the histologic examination of the trans-bronchial biopsy and pleural biopsy showed necrotizing granuloma and helped to narrow down the diagnosis. The patient improved with RIPE therapy.
CONCLUSIONS: This case illustrates the diagnostic difficulty of disseminated TB with atypical organ involvement. Culture is the gold standard for diagnosing TB but is a long process and with 23% of culture negative TB in the United-States, the diagnosis sometimes relies on thoroughly ruling-out differential diagnosis and histologic examination.