DIFFERENT PRESENTATION OF TUBERCULOUS ORCHITIS: CASE SERIES

Abstract

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Extrapulmonary tuberculosis (TB) still presents a diagnostic and therapeutic challenge. Genitourinary TB constitutes about 20% of the extrapulmonary cases in regions where TB is endemic. Where TB is found in unexpected sites, its positive diagnosis remains important. Tuberculous infection of epididymis and testis is difficult to differentiate clinically from pyogenic infection, tumour or infarction. The clinical presentation of genitourinary tuberculosis (TB) may be variable and a high index of suspicion is required for a timely diagnosis, especially in endemic areas. Scrotal ulcers associated with epididymo-orchitis should alert the clinician of a possible diagnosis of TB. Isolated tuberculous epididymo-orchitis may closely mimic testicular tumour particularly in patients with no history of systemic TB thereby presenting a diagnostic and treatment challenges. CASE PRESENTATION: Case1: 49 years old immunocompetent male smoker came with swelling and pus discharging ulcer in right testis for 3 months. Genital examination showed ulcer over posterior aspect and sinus over anterior aspect of the enlarged scrotum. His chest x ray was normal. USG scrotum echogenic collection with specks of calcification in TV sac. Sinus tract was excised and CBNAAT shows rifa sensitive MTB. Case2: 55 years old immunocompetent male, never smoker came with dry cough, right sided scrotal pain with pus discharging ulcer of 20 days duration. He denied prior ATT, and had no contact with tuberculosis. USG scrotum showed anechoeic collection in right TV sac. CXR showed air space opacity on right upper zone. Sputum: AFB 1+ , CBNAAT: rifa sensitive, MTB detected low. Discharge from ulcer in CBNAAT showed rifa sensitive MTB. Case3: 28 years old immunocompetent male had scrotal swelling of 6 months duration. No constitutional symptoms. Had prior ATT taken only 3 months for HPE proved TB right cervical adenitis. Genital examination showed sinus tract in posterior aspect of right scrotum. USG scrotum shows scrotal wall abscess suggestive of tuberculosis. Sinus tract excision has epitheloid granuloma without caseous necrosis and CBNAAT had rifa sensitive MTB. All 3 cases showed free from symptoms and partial resolution of ulcer after 2 months of ATT. DISCUSSION: Tuberculous epididymitis may be the presenting symptom of genitourinary TB. It usually presents as a painful, inflamed scrotal swelling but occasionally can present as a draining sinus on the posterior surface of the scrotum. TB orchitis without epididymal involvement is very rare. It is most common in young (20-40 years), sexually active males but here in middle age group also involved. CONCLUSIONS: The clinical presentation of genitourinary tuberculosis (TB) may be variable and a high index of suspicion is required for a timely diagnosis, especially in endemic areas. Sebaceous cyst is the commonest swelling that occurs in the scrotal skin. Reference #1: AlZayyani, N. R., Wani, A. M., Al Miamini, W. & Al Harbi, Z. S. Chronic epididymo-orchitis and scrotal ulcers. BMJ Case Rep. (2011) doi:10.1136/bcr.03.2010.2825. Reference #2: Shenoy, V. P., Viswanath, S., D’Souza, A., Bairy, I. & Thomas, J. Isolated tuberculous epididymo-orchitis: An unusual presentation of tuberculosis. J. Infect. Dev. Ctries. (2012) doi:10.3855/jidc.2145. Reference #3: Khan, A., Singaraddi, R., Shetty, D. & Rodrigues, G. Primary cutaneous ‘ulcerative’ tuberculosis of the scrotum: A rare occurrence. BMJ Case Rep. (2018) doi:10.1136/bcr-2018-227177. DISCLOSURES: No relevant relationships by UMAPATHI SIVASUBRAMANIAM, source=Web Response