Isolated Epididymitis Tuberculosis in an Adolescent Male: When Foresight Clinical Decisions Determine the Right Diagnosis

Abstract Background: Urogenital tuberculosis (UGTB) is one of the common extrapulmonary TB in children. One form of UGTB is epididymitis TB, which is reported rarely in children. Epididymitis TB presented with unspecific chronic clinical manifestation and definitive diagnosis made by bacteriological confirmation due to paucibacillary and histopathology findings. Case presentation: A 16-year-old boy had been admitted to the hospital due to painful swelling of the left scrotum in the last three month. Persistent coughing for 2 months was reported. Physical examination of the left scrotum showed swelling accompanied by cardinal signs. Palpable hard mass on the left scrotum, firm borders, pain, measuring 7x4 cm. Laboratory examination was within normal limits, tumor markers (AFP, CEA, LDH) within normal limits, and routine urinalysis showed leukocyturia. Genital ultrasound showed epididymitis sinistra with septal hydrocele. Genital MRI showed left epididymitis with bilateral inguinal lymph node enlargement. TB evaluation examination showed a PPD test of 0 mm and a negative bacteriologic examination, but CXR showed perihilar lymphadenopathy. The patient was diagnosed as isolated TB lymphadenitis and received quadruple ATT for two months, followed by RH for four months. After treatment, the size of the left testicle decreased and was equal to that of the right; no signs of inflammation were found, weight increased by 5 kg, and cough disappeared. However, sperm analysis at the end of treatment showed teratozoospermia. The patient is currently being treated for teratozoospermia by urologic surgery colleagues. Conclusions: Biopsy and culture testing for TB epididymitis confirmation are difficult to perform in the clinical setting. TB epididymitis should be considered in adolescent boys with complaints of chronic scrotal swelling and pain. Clinical judgment based on history taking, physical examination, and radiologic features supporting the picture of tuberculosis is helpful to diagnose correctly and quickly for a favorable outcome.