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Genitourinary tuberculosis, the second most common extrapulmonary tuberculosis (TB), is very difficult to diagnose unless one maintains a
high index of suspicion. Isolated tuberculous epididymitis (ITE), defined as tuberculous epididymitis without clinical evidence of either renal or
prostate involvement, is a rare entity among genitourinary tuberculosis. When diagnosed correctly, ITE can be cured with anti-TB medi-cations.
However, patients with poor response to medical treatment may require surgery. Here, we report a 20-year-old man who presented with a slow-
growing painless scrotal tumor for 2 months, with the initial workup suspicious for a right paratesticular tumor. Surgical resection of the tumor
was therefore scheduled. However, severe pain and redness over the patient’s right hemi-scrotum were noted on the day of surgery. A repeat
scrotal ultrasound was performed that revealed findings suggesting a chronic inflammatory process rather than a malignancy. Frozen section of
the lesion confirmed the ultrasonographic findings, and the pathology established the diagnosis of ITE. The patient remained on anti-TB therapy
postoperatively for 6 months and had an excellent outcome.
Copyright 2012 Elsevier Taiwan LLC and the Chinese Medical Association. All rights reserved.
Keywords: genitourinary tuberculosis; isolated tuberculous epididymitis; orchiectomy; scrotal tumor; scrotal ultrasound
2
1. Introduction system as the three most common extrapulmonary sites.
Evidences from the literature suggest that the infecting
The present incidence and prevalence of tuberculosis (TB) Mycobacterium tuberculosis bacilli reach the kidney through
has not changed significantly for decades due to the emigra- hematogenous spread from the lungs, then spread down the
3
tion of people born in endemic areas of TB, the growing ureter, bladder. and/or prostate. Isolated tuberculous epidid-
population positive for human immunodeficiency virus (HIV) ymitis (ITE), defined as TB epididymitis without clinical and
infection, and the emergence of multidrug resistant strains of laboratory evidence of renal involvement, is usually rare and
Mycobacterium. Despite strict implementation of control 4
difficult to diagnose. Although the typical symptoms and
measures, TB remains one of the leading causes of death imaging signs of epididymal TB have been described by
among notifiable diseases in Taiwan, with an estimated 15,000 5
Madeb et al, the definitive diagnosis of ITE can only be
new cases and approximately 8000 sputum-smear positive confirmed by positive cultures, ZiehleNeelson staining, and/
1 1
cases reported annually. Chang et al reported that the inci- or histopathologic examination. In this report, we present a
dence and mortality rates of TB for aborigines in eastern case of ITE initially presenting as a scrotal tumor that was
Taiwan were 3.1 and 3.2 times higher, respectively, than the diagnosed by histopathologic examination of the surgical
rates for the general population in Taiwan. specimen and managed later with anti-TB medications for 6
Extrapulmonary TB can develop in a variety of locations, months.
with the skeletal, genitourinary tract, and central nervous
2. Case report
* Correspondence author. Dr. Pei-Hui Chan, Division of Urology, Depart- A 20-year-old man, recently discharged from military
ment of Surgery, Far Eastern Memorial Hospital and Medical Center, 21,
Section 2, Nan-Ya South Road, Banciao, New Taipei City 220, Taiwan, ROC. service in eastern Taiwan, came to our clinic due to a slow-
E-mail address: pfchan1952@yahoo.com.tw (P.-H. Chan). growing painless scrotal tumor for the preceding 2 months.
1726-4901/$ - see front matter Copyright 2012 Elsevier Taiwan LLC and the Chinese Medical Association. All rights reserved.
doi:10.1016/j.jcma.2013.04.014
V.K.-S. Kho, P.-H. Chan / Journal of the Chinese Medical Association 75 (2013) 292e295 293