Beyond typical orchiepididymitis: a urological presentation of disseminated tuberculosis

Abstract

Extrapulmonary tuberculosis can include severe disseminated forms, even in immunocompetent individuals. We present the case of a 43-year-old HIV-negative man with recurrent abdominal pain and a painful scrotal mass, initially treated as orchiepididymitis. Further study revealed a miliary pulmonary pattern and genitourinary involvement, with tuberculosis confirmed by molecular analysis in bronchoalveolar lavage. The patient later developed neurological involvement, with MRI showing ring-enhancing lesions and CSF PCR confirming tuberculous meningitis. Treatment with primary regimen and corticosteroids led to clinical improvement and resolution of testicular involvement, avoiding orchiectomy. This case highlights an unusual presentation of disseminated tuberculosis, emphasizing the importance of a comprehensive diagnostic approach and molecular techniques in subacute multi-organ presentations in endemic settings.