Isolated Tuberculous Testicular Abscess Without Systemic Involvement: A Rare Cause of Scrotal Swelling

Genitourinary tuberculosis most commonly involves the epididymis; isolated testicular involvement is rare and usually presents as a mass mimicking malignancy. Genitourinary tuberculosis presenting as a localized testicular abscess without evidence of tuberculosis elsewhere in the body is particularly uncommon.

A 60-year-old male presented with right scrotal swelling of 2 months' duration associated with low-grade fever. He reported no urinary symptoms and no weight loss. Clinical examination revealed an enlarged right testis with loss of normal testicular architecture. Ultrasonography showed a heterogeneous hypoechoic lesion predominantly replacing the right testis, with central liquefaction suggestive of an intratesticular abscess. The contralateral testis was normal. Routine blood tests, renal and liver function, and tumor markers (alpha-fetoprotein, beta-human chorionic gonadotropin, lactate dehydrogenase) were within normal limits. Chest radiograph and abdominal ultrasound excluded pulmonary and renal tuberculosis. The patient underwent right inguinal orchidectomy for diagnosis and management. Histopathology demonstrated granulomatous orchitis with caseous necrosis and Langhans giant cells consistent with a tubercular etiology. No evidence of malignancy was seen. Postoperatively, the patient received a 6-month course of first-line antitubercular therapy. The patient had a good clinical recovery, and at follow-up had no evidence of disease.

In endemic regions, isolated tuberculous testicular abscess should be considered in the differential diagnosis of testicular abscesses. Orchidectomy is useful diagnostically and therapeutically for patients with irreversibly damaged testicular tissue or suspicion of malignancy.