Tuberculous epididymitis presenting as non-healing ulcers in a young male patient: A case report

ABSTRACT Tuberculosis (TB) mainly affects the lungs, having extrapulmonary manifestations. Among extrapulmonary TB, genitourinary TB (GUTB) constitutes 15% to 20% of all cases. The source of infection of GUTB may be a hematogenous spread from the lungs or by retrograde spread of infection from the bladder or prostate. In a majority of the GUTB cases, epididymis is mostly involved. Symptoms may be variable, and sometimes non-healing ulcers (NHUs) may be the only manifestation of GUTB. Along with NHUs, other characteristics such as past history of fever, incomplete resolution of the ulcers with conventional drugs, and presence of constitutional symptoms prompt suspicion of tuberculous etiology. Investigations like Mantoux test, mycobacterial culture, magnetic resonance imaging (MRI), and high-resolution ultrasonography were done to establish the possible diagnosis. Treatment with anti-tuberculous therapy (ATT) with four drugs for 2 months and two drugs for 4 months may result in complete resolution of lesions without recurrence. Hence, we report a rare case of TB epididymitis in a young male patient presenting as non-healing ulcers over the scrotum for long duration with positive sonographic features and complete resolution of the ulcers after a six-month course of ATT without recurrence.