Unraveling the Clinical Quandary: Cryptic Tuberculosis or Splenogonadal Malignancy?

Tuberculosis continues to persist as a significant health problem in multiple parts of the world despite global efforts to eradicate it. A high variability in the clinical manifestation hinders the early diagnosis. Atypical presentations like "cryptic tuberculosis" lack classic clinical and radiological features of the disease and can mimic metastatic cancer, posing a diagnostic challenge. Herein, we report a case of a 70-year-old male with complaints of chronic abdominal pain, who was presumed to have malignant disease of the spleen and testis after clinical and radiological assessment. However, the histopathology and microscopy revealed features of tuberculosis, and a culture test confirmed the diagnosis. Hence, clinicians should be vigilant of the ambiguity of symptoms, especially in immunosuppressed patients and among residents of endemic areas. This can target aggressive efforts to diagnose and treat such unusual presentations of tuberculosis, avoiding unwanted mortality.