Male genital tuberculosis

Summary

A 51-year-old man presented with painless left testicular swelling for 1 month, with fevers, chills, night sweats, weight loss, and increased difficulty voiding over 6 months. He underwent radical orchiectomy; surgical pathology revealed granulomas containing acid-fast bacilli in the testis and epididymis. Male genital tuberculosis was diagnosed using nucleic acid amplification on urine and confirmed by positive urine and sputum cultures for Mycobacterium tuberculosis. Genital disease is an unusual extrapulmonary manifestation of tuberculosis, often seen in middle-aged men with renal or pulmonary tuberculosis. Clinical findings are variable, but commonly include dysuria with sterile pyuria or a painless testicular mass. Initial diagnosis is often incidentally made on pathological specimens and confirmed with nucleic acid amplification and cultures. Treatment using a standard four-drug regimen is usually sufficient; surgery is rarely required. This case is used to raise awareness of, and formulate a minimally invasive diagnostic approach to, this unusual but important entity.

Introduction

After lymphatic involvement, genitourinary tuberculosis is considered the most common manifestation of extrapulmonary tuberculosis worldwide, involving up to 46% of cases.1, 2, 3 Male genital tuberculosis is an uncommon subset of genitourinary tuberculosis involving the prostate, seminal vesicles, vas deferens, testes, epididymides, or penis. One of the first modern descriptions of male genital tuberculosis was published in 1879, 3 years before Koch discovered Mycobacterium tuberculosis.⁴ Since the first cases of HIV were documented, the incidence of extrapulmonary tuberculosis has been rising.⁵

We describe a case of tuberculosis involving the testis. We then review the epidemiology, clinical findings, diagnostic challenges, and standard therapy for male genital tuberculosis, a rare and poorly recognised disease.