A communicable infectious disease, tuberculosis is mostly localised in the lungs, accounting for the majority of cases and contagious forms of the disease. Additionally more common in women, black individu- als, and people with compromised immune systems is extra-pulmonary tuberculosis. We present the case of a black subject with testicular tu- berculosis who did not have any concomitant immunological deficien- cies. The clinical presentation included pain and a testicular mass that required multiple examinations by ultrasonography, which suggested a cord cyst. The cyst recurred after two surgeries, and the final diagnosis of tuberculous orchidymitis was made based on anatomopathological analysis of a testicular mass biopsy specimen. Following the start of an- tituberculous treatment for six months, the evolution was positive.
Short Communication A peculiar type of cancer is testicular tubercu- losis. Bidaw Héassoua Rawè Department of Infectious and Tropical Diseases, Sylvanus Olympio University Hospital, Lomé-Commune Regional Hospital, Togo. *Corresponding Author : Bidaw Héassoua Rawè, Department of Infectious and Tropical Diseases, Sylvanus Olympio University Hospital, Lomé-Com- mune Regional Hospital, Togo. Received : July 26, 2023 Accepted: July 27, 2023 Published : August 27, 2023 Abstract
A communicable infectious disease, tuberculosis is mostly localised in the lungs, accounting for the majority of cases and contagious forms of the disease. Additionally more common in women, black individu- als, and people with compromised immune systems is extra-pulmonary tuberculosis. We present the case of a black subject with testicular tu- berculosis who did not have any concomitant immunological deficien- cies. The clinical presentation included pain and a testicular mass that required multiple examinations by ultrasonography, which suggested a cord cyst. The cyst recurred after two surgeries, and the final diagnosis of tuberculous orchidymitis was made based on anatomopathological analysis of a testicular mass biopsy specimen. Following the start of an- tituberculous treatment for six months, the evolution was positive. Keywords : Tuberculosis; Testicle; Black race; Togo INTRODUCTION For a sizable portion of the global population, tuberculosis— also known as Koch’s bacillus, or KB—remains a public health concern. It is a contagious infectious disease. The World Health Organisation (WHO) lists it as one of the infectious diseases that kill the most people worldwide. After HIV infection, it is the sec- ond most frequent cause of infectious disease-related mortality [1]. As with the most of infectious types of tuberculosis, pul- monary locations account for the vast majority of occurrences [1]. Extrapulmonary tuberculosis is common, with rates rang- ing from 20 to 40%, contingent on the series. They are more common in immunocompromised people, women, and Black subjects. According to WHO statistics, 14% of tuberculosis cases world- wide are extra-pulmonary diseases without concurrent pulmo- nary involvement. The three most typical involvement types are osteoarticular, pleural, and lymph node [1]. Rarely occurs isolat- ed testicular tuberculosis. Because tubercle bacilli are difficult to diagnose, diagnostic and treatment care are delayed [2]. In this paper, we present a case of testicular tuberculosis in a sub- ject with a good socioeconomic status who did not have any concomitant immunological deficiencies. Ethical Considerations Anonymity of the patient was maintained. The patient cannot be identified based on the results of the revealed anatomi- cal-pathological test. The 36-year-old patient had a unilateral testicular tumour, which eventually became bilateral, and had been the continuously evolving symptomatology for around 5 years. The right testicle started to enlarge and hurt in January 2015, necessitating a testicular ultrasound on January 14, 2015, which showed a big left epididymis with two hypoechoic nod- ules measuring 14 mm and 12 mm, respectively, suggesting ep- ididymitis nodules. The original cord cyst diagnosis was kept. In response to this outcome, the urologist conducted a nodulec- tomy-style procedure that same year. Even with this surgery, the left side’s evolution was characterised by ongoing pain.On August 03, 2015, a second testicular ultrasound revealed a 13 mm fluid formation of the left spermatic cord, with a wall sug- gesting a possibility that the cyst was likely superinfected and receiving antibiotic treatment. A second testicular ultrasound was performed on May 25, 2016, due to the signals’ persistence. The findings included mild bilateral testicular hypotrophy, nor- mal epididymides, a left hydrocele blade, and a small, 15 x 11 mm cyst that was likely formed in the left spermatic cord. In July 2016, a second surgical operation involving a left cystectomy was carried out. www.directivepublications.org Page - 1 Journal of Digestive and Liver Diseases
Short Communication The following was made possible by post-operative ultrasonog- raphy checks: A. January 24, 2017: a simple, low-abundance left hydrocele was linked to right pachyvaginalitis. B. On February 24, 2017, there was a 50 mm right scrotal ab- scess with homolateral epididymal infiltration (whose puncture returned a purulent discharge) and a minimally abundant left hydrocele. C. Chronic right orchi-epididymitis with intra-scrotal abscessed collections undergoing fistulization on April 12, 2017. D. Right caudal epididymitis in the subacute phase, September 09, 2019. E. October 31, 2020: remodelled spermatic cord cysts, sparse hydrocele, and right testicular enlargement linked to stage I mi- crolithiasis. A biopsy specimen of the testicular mass taken on December 31, 2020, underwent anatomopathological testing. The results confirmed necrotizing and granulomatous epididymitis, which may be a component of tuberculous orchi-epididymitis at the caseo-follicular stage. The desired chest X-ray, which was part of the search for a pulmonary focus, came back normal. The patient did not exhibit weight loss, tuberculous impregnation, or tuberculous contagion during the questioning. He weighed eighty-five kilogrammes. The scar from the BCG vaccination as a child was apparent on the left arm’s anterior surface. Other tests that were performed included: a. A negative retroviral serology. b. A CD4 cell count of 1370 cells/mm3. c.Normal blood glucose level after fasting is 0.96 g/l. d.7% glycated haemoglobin is normal. e. Anti-HCV antibodies are negative. f. Complete anti-HBc and anti-HBs antibody positivity (previ- ous hepatitis B cured). g. The 15 mm intradermal tuberculin test result was positive. The following protocol was followed to start a 6-month anti-tu- berculosis treatment based on rifampicin (R), isoniazid (H), pyr- azinamide (Z), and ethambutol (E) in January 2021: i. Four anti-tuberculosis medications (RHZE) combined for two months is the first phase of treatment. ii. After that, the second phase involves combining two import- ant anti-tuberculosis medications (RH). a corticosteroid treatment consisting of 20 mg of Prednisone given for two weeks at a dose of 1 mg/kg, and then for a month at a declining dose. Following the first phase of treatment, on March 10, 2021, an ultrasound examination was performed. The results showed that the patient had stage I microlithia- sis-related left testicular hypotrophy, a sparse hydrocele, a nor- mal right testicle, and a normal epididymis without varicocele. Discussion Male TB with isolated testicular location is rare [3]. In the ab- sence of other suggestive localizations, a theory of transmis- sion, or a history of tuberculosis, the diagnosis is sometimes challenging and delayed [4]. With our patient, this was the situ- ation. With the exception of cases of superinfection, which can result in the diagnosis of a testicular tumour or chronic orchi- epididymitis, the clinical picture is typically that of chronic epi- didymitis or orchi-epididymitis developing in an environment of minimal pain [5]. The diagnosis may be guided by the existence of a scrotal fistula and/or an enlarged or nodular epididymis [3]. HIV infection favours TB localizations outside of the lungs. Localization of the testicles appears to be an exception [4]. Reports of testicular tuberculosis have been made in a num- ber of people under 40 years of age, none of whom had im- munosuppression, especially not in relation to HIV [4,6,7]. In 50 to 75 percent of cases, male genital localization happens by a ductal or lymphatic pathway and is typically due to urinary in- volvement [8]. Local symptoms are typically subtle and develop over time. In isolated genital TB, systemic symptoms such fever, chills, and sweats are uncommon [9]. In this instance, our pa- tient showed gradual evolution in his genitalia for a number of years without showing any symptoms of tuberculous impregna- tion, and the possibility of tuberculosis had not been explored until much later. Conclusion It is uncommon to have isolated or binocular testicular TB, as we do. Bacteriuria is not always positive, and the clinical and epidemiological context—which includes contagions and relat- ed pathologies—must inform the diagnostic strategy. Anato- mo-pathological examination of testicular biopsy specimens validates the diagnosis in every instance, and a properly admin- istered anti-tuberculosis antibiotic therapy guarantees a cure in every instance. www.directivepublications.org Page - 2 Journal of Digestive and Liver Diseases
Short Communication REFERENCES 1. Mjid M, Cherif J, Ben Salah N, Toujani S, Ouahchi Y, et al. (2015) Épidémiologie de la tuberculose. Revue de Pneu- mologie Clinique 71(2- 3): 67-72. 2. Rakototiana AF, Hunald FA, Razafimanjato N, Ralahy MF, Ra- koto-Ratsimba HN, et al. (2009) Isolated testicular tuberculosis in children. Report of 2 Malagasy cases. Ar- chives de Pédiatrie 16(2): 112- 114. 3. Joual A, Rabii R, Guessous H, Benjelloun M, El Mrini M, et al. (2000) Isolated testicular tuberculosis: about a case. Annals of Urology 34(3): 192-194. 4. Solofomalala GD, Rakotoarisoa AJC, Rakotosamimanana J, Rabarioelina L (2006) A case of testicular tuberculosis seen in Antana- narivo. Médecine Tropicale 66(1): 97-98. 5. Riehle RA, Jayaraman K (1982) Tuberculosis of testis. Urol- ogy 20(1): 43-46. 6. Agoda-Koussema LK, Tchaou M, Adjénou V, Sonhaye L, Anoukoum T, et al. (2011) Heterogeneous testicle on ul- trasonography: consider tu- berculosis after cancer in en- demic zone. Médecine tropicale : revue du Corps de santé colonial 71(1): 100. 7. Ouedraogo M, Boncoungou K, Ouedraogo SM, Hien S, Drabo YJ (2001) La tuberculose épididymo-testiculaire à propos d’un cas. Mé- decine d’Afrique Noire 48(5): 217- 218.
8. Bensouda A, Reffad J, Kabbaj MM, Karmouni T, Tazi K, et al. (2007) La Tuberculose Genitale Masculine: A Propos de 22 Cas. African Journal of Urology 13(2): 145-150. 9. Gorse GJ, Belshe RB (1985) Male genital tuberculosis: a review of the literature with instructive case reports. Rev Infect Dis 7(4): 511-524. www.directivepublications.org Page - 3 Journal of Digestive and Liver Diseases