Tuberculous epididymo-orchitis masquerading as acute scrotum

Area of Science:

• Urology
• Infectious Diseases
• Public Health

Background:

• Testicular pain in young individuals often suggests epididymo-orchitis.
• Refugees from endemic areas may present with atypical infections.
• Delayed diagnosis of tuberculosis can lead to severe complications.

Observation:

• An 18-year-old Afghan refugee presented with severe testicular pain, initially diagnosed as epididymo-orchitis.
• He later developed a testicular abscess, confirmed as tuberculous infection.
• The patient had risk factors for tuberculosis but received a delayed diagnosis.

Findings:

• Surgical drainage of the abscess facilitated laboratory confirmation of tuberculous infection.
• A 9-month regimen of standard anti-tuberculosis drugs (isoniazid, rifampicin, ethambutol, pyrazinamide) with vitamin B6 resulted in a good clinical response.
• This case highlights the importance of considering tuberculosis in the differential diagnosis of testicular abscesses, especially in high-risk populations.

Implications:

• Clinicians should maintain a high index of suspicion for tuberculosis in patients with testicular abscesses, particularly those with relevant epidemiological risk factors.
• Prompt diagnosis and appropriate anti-tuberculosis therapy are essential for managing this condition and preventing long-term sequelae.
• Public health strategies should address the screening and management of tuberculosis in refugee populations to mitigate risks of delayed diagnosis and treatment.