Tuberculosis (TB) is a global concern, with 10.6 million cases reported in 2021 alone. TB can occur in all age groups and in all countries, but it can be prevented and treated. While TB commonly affects the lungs, it can also affect other parts of the body, known as extrapulmonary TB. Genitourinary TB is a type of extrapulmonary TB that can affect both immunocompromised and immunocompetent patients. Male genital TB is rare, and it often occurs in conjunction with renal TB. The prostate and epididymis are the most commonly affected areas, and epididymitis is often associated with isolated testicular TB, which is also a rare condition. Unfortunately, diagnosing these conditions can be difficult due to ambiguous symptoms and imaging test results, which often require invasive diagnostic procedures. While molecular techniques for detecting early mycobacteria DNA have become more advanced, cultures remain crucial for making a reliable microbiological diagnosis.
This article aims to report two rare cases of testicular TB. The first case involves an 18-year-old male patient who presented with right testicular swelling, fever, night sweats, and an ulcer. After the physical examination and laboratory tests, a biopsy confirmed the diagnosis of testicular TB, and the patient was prescribed a treatment plan consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol. The patient was monitored closely throughout the treatment period.
The second case was a 26-year-old male patient who complained of fever, night sweats, and severe right testicular swelling and pain. He had previously been treated for respiratory TB 11 years earlier and was a smoker but non-alcoholic. Due to a small testicular tumor, he was initially treated at another hospital but was eventually diagnosed with TB, and the treatment plan consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol was initiated. After six months of treatment, the patient experienced improvements in his symptoms, and subsequent testicular ultrasounds showed a decrease in nodule size.
While TB can affect many organs in the genitourinary region, it is rare for it to affect the testicles, accounting for just 0.5% of all genitourinary cases. Given the infrequency of isolated testicular involvement, it is essential to consider other possible conditions such as testicular tumor and other granulomatous infections in the differential diagnosis. Physicians must avoid unnecessary orchiectomies by making a definitive diagnosis, which usually requires histological results.
Diffuse testicular size, heterogeneous or homogeneous hypoechoic nodular lesions can be seen on ultrasonography. Testicular biopsy is an important method for diagnosing testicular TB, and FNAB is also useful as it can reveal epithelioid granulomas, while bacilli can be detected by acid-fast staining (ARB), although ARB positivity is not always present. In addition to the combination of medical history, testicular ultrasound, and FNAB, anti-tuberculosis treatment can be used for diagnosis and treatment, especially in areas where it is not possible to confirm the diagnosis with ARB or culture.
Testicular TB treatment usually involves the use of a quadruple (isoniazid, rifampicin, pyrazinamide, and ethambutol) for six months, and cure is achievable in many cases. In rare cases, surgery is required, but its indication as a treatment option is minimal, primarily when complications arise.
In conclusion, testicular TB is a rare form of TB that requires a histological diagnosis before treatment can commence. Clinicians should always take into account the patient’s medical history, examination results, and ultrasonography when diagnosing testicular TB. In addition, appropriate use of FNAB and medical history can aid in the diagnosis of TB orchitis in areas where testing and culture are not available. Above all, a high degree of suspicion is critical in diagnosing testicular TB in young men, especially in cases where they have resided or traveled to TB endemic regions.
