Testicular tuberculosis in multidrug-resistant pulmonary tuberculosis

Area of Science:

• Infectious Diseases
• Pulmonology
• Urology

Background:

• Tuberculosis (TB) is a significant global health concern, primarily affecting the lungs.
• Multidrug-resistant tuberculosis (MDR-TB) poses a growing challenge to treatment efficacy.
• Extrapulmonary TB, including testicular involvement, is less common but clinically important.

Observation:

• A 25-year-old immunocompetent male presented with symptoms initially suggestive of testicular cancer.
• Radical orchiectomy revealed granulomatous inflammation with acid-fast bacilli in the testis.
• Bronchial washing fluid cultures confirmed Mycobacterium tuberculosis infection.

Findings:

• The isolated Mycobacterium tuberculosis strain demonstrated resistance to isoniazid, rifampin, and ethambutol, classifying it as MDR-TB.
• Histopathological examination of the testis confirmed tuberculous granuloma, indicating testicular TB.
• This case represents the first reported instance of testicular TB in a patient with MDR pulmonary TB.

Implications:

• This case underscores the importance of considering TB in the differential diagnosis of testicular masses, even in immunocompetent individuals.
• The occurrence of MDR-TB in both pulmonary and testicular sites highlights the potential for disseminated disease and treatment complexities.
• Further research is needed to understand the pathogenesis and optimal management strategies for disseminated MDR-TB, particularly with extralung involvement.