FDG PET/CT in a Case of Bilateral Tuberculous Epididymo-orchitis.

Isolated genital tuberculosis is rare. We present a case of bilateral tuberculous epididymo-orchitis showing high FDG uptake on FDG PET/CT. In addition, the patient had a prostatic FDG-avid lesion, consistent with tuberculous prostatitis. This case indicates tuberculous epididymo-orchitis, especially in tuberculosis-endemic regions, should be considered as a differential diagnosis in patients with hypermetabolic epididymal or testicular lesions, including benign and malignant tumors, bacterial epididymo-orchitis, abscess, idiopathic granulomatous orchitis, and sarcoidosis.

Vas deferens sonographic appearances of tuberculosis lesions of 19 cases of male genital systemic tuberculosis.

To investigate the sonographic findings of the vas deferens in male genital tuberculosis.The ultrasonographic findings of the vas deferens of 19 cases of genital tuberculosis were retrospectively analyzed.According to the pathological and ultrasound findings, the ultrasonographic appearances of the vas deferens tuberculosis could be divided into 4 groups, 1 of normal sonograms, 3 of abnormal sonograms. The abnormal ultrasonographic appearances of the vas deferens tuberculosis were considered 3 categories as follows: diffusely thickening of vas deferens, nodular thickening of vas deferens, and space-occupying lesions adjacent to the vas deferens.The ultrasound manifestations of vas deferens in tuberculosis of the male genital system have certain characteristics. Combination of clinical manifestations, history of tuberculosis, experimental antituberculosis treatment, and ultrasound examination of vas deferens can suggest tuberculosis of vas deferens. Furthermore, it can provide objective basis for the comprehensive and noninvasive evaluation of the impact of genital tuberculosis on the reproductive ability for further treatments.

Pulmonary and testicular tuberculosis in one patient caused by Mycobacterium tuberculosis with different genotypes.

Extrapulmonary tuberculosis (EPTB) accounted for 14% of 6.4 million cases of TB that were reported to WHO in 2017, and genitourinary TB (GUTB) is the second most common type of EPTB. The most common site of GUTB is the kidneys and testicular TB is relatively rare. The case of one patient with pulmonary and testicular TB caused separately by two different genotypes of Mycobacterium tuberculosis (Mtb) is further rare. Here, we present an unusual case of TB in which pulmonary TB (PTB) and testicular TB were caused by Mtb isolates with two different genotypes in a 91-year-old male patient from Zunyi, Guizhou Province of China. A better understanding of the mechanism by which a small number of tubercle bacilli are spread from the primary site of PTB to more distant parts/organs of the body, and what factors determine the potential EPTB site will provide us with new ways to prevent and control EPTB infections.

Two unusual reports of urogenital tuberculosis: One 'putty' kidney and another in association with benign prostatic hyperplasia.

In India urogenital tuberculosis is the second commonest form of extra-pulmonary tuberculosis. Kidney is the highest and prostate is the least affected urogenital organ. But the extreme stage of renal tuberculosis named as 'putty' kidney is a rare manifestation. In general most cases of urogenital tuberculosis are quasi-symptomatic, and therefore an uttermost apprehension is needed from physicians to intercept such cases at the earliest. In this presentation we describe a case of 'putty' kidney, and another incidental association of prostate tuberculosis with benign prostatic hyperplasia.

Primary cutaneous 'ulcerative' tuberculosis of the scrotum: a rare occurrence.

Tuberculosis (TB) is a global disease and if not adequately treated can lead to morbidity and mortality. Though genitourinary TB is common and only next to pulmonary TB, cutaneous 'ulcerative' tuberculosis of the scrotum is not reported so far in the literature. We present a 32-year-old man with a non-healing scrotal ulcer and underwent excision. Histopathology was consistent with TB. Antitubercular therapy was given and at the end of a year's follow-up, there has been no recurrence. TB of the scrotum should be considered in the differential diagnosis of scrotal ulcers. Proper diagnosis and adequate treatment will offer a cure to such patients.

Incidentally detected tuberculous prostatitis with microabscess

ABSTRACT Tuberculous prostatitis is a rare and often overlooked entity that may mimic prostatic adenocarcinoma on imaging exams, especially multiparametric magnetic resonance imaging (MRI) of the prostate. Detection of a prostatic abscess is a clue to the correct diagnosis.

Quantitative polymerase chain reaction analysis of serpiginous choroiditis with biopsy-proven testicular tuberculosis.

We report a case of a 47-year-old male patient presenting with diminution of vision in the left eye. The left eye fundus showed yellowish lesions with indistinct geographical margin extending over the posterior pole just abutting the macula, suggestive of diffuse choroiditis. The patient gave a history of testicular swelling for the past 2 years. Aqueous tap for polymerase chain reaction analysis was positive for IS6110 mycobacterial tuberculosis (TB) genome, and a biopsy of testicular sac was suggestive of tubercular epididymitis. A diagnosis of TB-multifocal serpiginoid choroiditis was established and was managed with anti-tubercular therapy and systemic steroids.

Tuberculosis epididymitis complicated by a cutaneous fistula.

A 63-year-old man developed scrotal swelling that became bilateral over 2 months. His symptoms persisted after treatment for epididymitis, and he developed a scrotal fistula with drainage. Mycobacterium tuberculosis grew from the urine and fistula. His symptoms resolved and fistula closed with medical therapy. His case highlights the importance of early recognition, diagnosis and treatment of this form of extrapulmonary tuberculosis.

Unmasking immune reconstitution inflammatory syndrome: a report of tuberculous epididymo-orchitis mimicking a testicular tumour in a Caucasian AIDS patient.

Worldwide, it is estimated that 14.8% of all new tuberculosis cases in adults are attributable to HIV infection. Genitourinary tuberculosis is a known complication and is considered to be a severe form of extrapulmonary tuberculosis. Isolated tuberculous epididymo-orchitis is rare. We report a Caucasian HIV-positive heterosexual male with a clinical diagnosis of testicular tumour for which he underwent a right orchidectomy. Tuberculous epididymo-orchitis was confirmed by histology. In this case, all Immune Reconstitution Inflammatory Syndrome (IRIS) criteria were met. We want to convey the message that in HIV-positive patients presenting with testicular swelling, an infective aetiology should be considered. This will increase the possibility of early diagnosis and proper management.

Patient with disseminated tuberculosis and rare perianal involvement / Paciente con tuberculosis diseminada y un raro compromiso perianal

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Synchronous presentation of two rare forms of extrapulmonary tuberculosis.

Tuberculosis (TB) remains one of the leading infectious causes of death throughout the world. Extrapulmonary forms, namely adrenalitis and prostatitis, are rare presentations of TB and pose a difficult diagnostic challenge, given their non-specific manifestations. The authors present a case of a 42-year-old man with long-standing symptoms of fatigue, anorexia, weight loss, nightly fever and sudoresis. He also suffered from sporadic vomiting and episodic hypotension, and had skin hyperpigmentation, as well as frequent urination, perineal discomfort and pain at ejaculation. Laboratory investigation confirmed primary adrenal failure. On CT scan there were two hypodense right adrenal nodules and bilateral lung condensations with a tree-in-bud pattern. Another hypodense nodule was seen in the prostate. TB was diagnosed by isolatingMycobacterium tuberculosisfollowing cultures of bronchoalveolar lavage, bronchial secretions, urine and ejaculate. Antibacillary treatment resolved the infectious lesions but the patient remained on corticosteroid replacement therapy for ongoing adrenal failure.

Tuberculous epididymo-orchitis masquerading as acute scrotum.

An 18-year-old boy, a refugee from Afghanistan, with no significant medical history, presented after 1 day of severe left testicular pain. History, clinical examination and scrotal ultrasound suggested the diagnosis of epididymo-orchitis. He was discharged on a 2-week course of amoxicillin/clavulanic acid. Six weeks later, he re-presented with a testicular abscess, continuous with the epididymal head. Incision and drainage led to laboratory confirmation of tuberculous infection. He was treated with isoniazid, rifampicin, ethambutol, pyrazinamide and vitamin B6 for 9 months, with good response. Despite meeting high-risk criteria for tuberculosis, our patient had a delayed diagnosis. We present the case and discuss the lessons learned.

[Metabolic syndrome as a cause of reduced ejaculate fertility in patients with prostatic tuberculosis].

INTRODUCTION: Metabolic syndrome (MS) negatively affects the quality of ejaculate, especially in patients with chronic prostatitis. MATERIAL AND METHODS: To determine the effect of metabolic syndrome on semen parameters in patients with tuberculosis of the prostate (TP), a study of 72 patients with prostatic tuberculosis was conducted. MS was diagnosed when at least three of the five following medical conditions were found: central obesity, elevated levels of plasma triglycerides, high blood pressure, hyperglycemia and decreased levels of high-density lipoproteins. Semen parameters were compared in patients with tuberculosis of the prostate with and without MS. RESULTS: 41% of patients with prostatic tuberculosis had metabolic syndrome, which was associated with a 1.5, 1.4 and 2.5 fold decreases in the number of sperm, sperm concentration, and the number of normal sperm forms, respectively. CONCLUSIONS: These findings provide the rationale for developing specific therapies aimed at restoring ejaculate fertility in patients with prostatic tuberculosis, considering that almost a half of them have MS.

[Cancer and genitourinary tuberculosis (literature review and clinical observations)].

Tuberculosis has been regarded as a counter-regulatory process to cancer. The development of tumors in the kidney that is affected by tuberculosis is considered as extremely rare, almost impossible case. The analysis of the literature on combined/sequential damage of urogenital organs by tuberculosis and cancer, and own clinical observation were performed. The case history of 72-year-old patient who sought medical advice for violation of urination is described. Previously he suffered from tuberculosis of the lungs and prostate cancer, and he was healed. The PSA level was 11 ng / mL. Urethroprostatogram showed a large cavity with calcification in the prostate. Biopsy of the prostate gland was performed; histologically solid-glandular cancer, Gleason 7 (3 + 4) was confirmed. There were no signs of tubercular inflammation. Radical prostatectomy was caried out; in the section, prostate caverns were filled with large fragments calcified caseation.Pathomorphological evaluation of surgical material has revealed proliferative glandular prostate cancer with invasion into the capsule of both lobes. In seminal vesicles invasion into muscle layer was detected. Tuberculosis can predetermine conditions for the development of a malignant tumor. In any case, the increase in PSA levels is an indication for prostate biopsy, especially if the patient had a history of long-term infectious inflammation of the prostate gland.

Isolated tuberculosis of tunica albuginea and tunica vaginalis presenting as acute hydrocoele: a diagnostic dilemma.

We report the first case of genital tuberculosis (TB) occurring in tunica albuginea (TA) and tunica vaginalis (TV) presenting as acute hydrocoele. A 35-year-old man presented with acute onset left scrotal swelling. Physical examination revealed left hemiscrotal swelling with overlying skin erythema and tenderness. Surgical exploration was carried out due to increasing pain and per operatively found thickened TA and TV with a single small nodule on TA. Histopathology revealed typical granuloma formation, however, no Mycobacterium was seen. Subsequent Ziehl-Neelsen stain on separate tissue specimen confirmed the presence of acid-fast bacilli. Based on these findings, antituberculous treatment was started involving daily isoniazid (INH), rifampicin, ethambutol and pyrazinamide for 2 months and further INH and rifampicin for further 4 months.