A Case of Disseminated Tuberculosis Presenting as Scrotal Swelling

Abstract

A 28-year-old male patient presented with right-sided scrotal swelling and pain for the past two months. He had a history of loss of appetite and weight, as well as fever for the past ten days. He had no comorbidities. Complete blood count and blood chemistry, including fasting blood glucose, renal, and liver function tests, were normal. Scrotal ultrasound revealed an enlarged right testis and epididymis with heterogeneous echotexture in the right testis and multiple small hypoechoic lesions within it. There was also a focal fluid collection with septations in the right scrotal sac, adjacent to the epididymis [Table/Fig-1]. Increased vascularity in the testis and epididymis indicated inflammation. These ultrasound findings suggested right epididymo-orchitis with an abscess in the extra testicular space of the right scrotal sac, near the epididymis. Abdominal ultrasound was normal. Chest X-ray revealed multiple miliary nodules in both lung fields and a small left-sided pleural effusion, which was confirmed on chest CT [Table/Fig-2a,b]. Contrast-enhanced magnetic resonance imaging of the brain showed multiple small enhancing lesions in the bilateral cerebral and cerebellar hemispheres, as well as the brainstem, with smooth leptomeningeal enhancement. These findings were suggestive of multiple tuberculomas with meningitis [Table/Fig-2c,d]. The patient later underwent drainage of right scrotal abscess and right epididymo-orchidectomy, as the epididymis had sloughed off due to infection [Table/Fig-3]. Mycobacterium tuberculosis was detected in the pus sample using the Mycobacterium tuberculosis DNA test, with no resistance to rifampicin. The patient responded well to antitubercular therapy and is currently being followed up.

Keywords

• epididymoorchitis
• ultrasound
• magnetic resonance imaging