Urogenital tuberculosis in a patient with persistent sterile pyuria

Urogenital tuberculosis (UGTB) can be a challenging diagnosis, and a delay in treatment may lead to irreversible organ damage. We report the case of a Guinean man in his 40s, residing in Portugal, who presented with lower urinary tract symptoms, urethral discharge and a right scrotal mass. Laboratory results revealed acute kidney injury, hypercalcaemia and persistent sterile pyuria, and ultrasound findings were suggestive of orchiepididymitis. Interferon gamma release assay was positive, as were the urine cultures for <i>Mycobacterium tuberculosis</i>, confirming the diagnosis of UGTB. The patient was initiated on tuberculostatic drugs, with a favourable response. This case emphasises the high degree of suspicion needed to establish the diagnosis of UGTB, which should be considered in patients with persistent sterile pyuria and a relevant epidemiological context.