Bilateral Tuberculous Orchi-Epididymitis: A Case Report and a Review of the Literature

Urogenital tuberculosis is secondary to infection with mycobacterium tuberculosis. It is the most severe form of an extra-pulmonary localization of the bacillus of Koch. We report the case of a 21-year-old patient, a student admitted for consultation for bilateral testicular pain that has been developing for 02 years by relapses and remissions, with onset of 01st of scrotal flow of clear fluid. History of exploratory scrototomy for suspicion of torsion of the spermatic cord two and a half years ago. The physical examination found a large acute bilateral pouch with two punctate orifices next to each testicle. The echography of the scrotum showed a cutaneous granuloma of the right purse of 07 mm in diameter; negative bacillus alcoholic acid resistant sputum, a normal chest x-ray; spermogram (azoospermia) and negative serology to HIV. An excision of the fistulous pathways was performed and found on histopathological examination a tuberculoid granuloma with caseous necrosis. The treatment consisted of antibacillary chemotherapy with favorable evolution. This observation illustrates the need to evoke a tuberculous orchi-epididymitis in front of a large painful scrotum in a man from an endemic region and shows the importance of early diagnosis.

Keywords: Bilateral Orchi-Epididymitis, Tuberculosis, Fistula, Azoospermia.