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Atypical testicular pain.

Nishant Bedi1, Muhammad Naim Che Rahimi1, Sarah Menzies2

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Testicular tuberculosis (TB) is rare and often misdiagnosed. DNA testing of hydrocele fluid confirmed TB in a patient initially treated for bacterial infection, highlighting diagnostic challenges.

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Area of Science:

  • Urology
  • Infectious Diseases
  • Radiology

Background:

  • Testicular tuberculosis (TB) is an uncommon condition.
  • Diagnosis is often delayed due to non-specific symptoms and mimicry of other diseases like bacterial epididymo-orchitis or malignancy.

Observation:

  • A 38-year-old male presented with symptoms mimicking bacterial epididymo-orchitis.
  • Failure to respond to standard antibiotic treatment prompted re-evaluation.
  • Unusual signs, including pulmonary nodules, lymphadenopathy, and bony changes on CT/MRI, raised suspicion for TB.

Findings:

  • Mycobacterium tuberculosis was confirmed via DNA-based testing of hydrocele fluid.
  • Standard acid-fast bacilli culture of the hydrocele fluid was negative.
  • The case highlights the diagnostic difficulties in testicular TB.

Implications:

  • This case underscores the importance of considering TB in the differential diagnosis of testicular conditions, especially with atypical presentations or systemic involvement.
  • Advanced imaging and molecular diagnostic techniques are crucial for accurate and timely diagnosis of rare conditions like testicular TB.
  • Reviewing diagnostic strategies for testicular TB is essential for improving patient outcomes.