Diagnostic Challenge of Epididymal Tuberculosis with Non-Specific Manifestation in a Low-Resource Setting
Case Report and Literature Review
DOI:
https://doi.org/10.56127/jukeke.v5i3.3076Keywords:
Scrotal Mass, Epididymal Tuberculosis, Diagnostic Accuracy, Case Report, Literature Review.Abstract
Epididymal tuberculosis is a form of genitourinary tuberculosis (GUTB) that presents with nonspecific clinical manifestations and may closely mimic other scrotal diseases, including malignancy. In low-resource settings, the lack of advanced imaging, cytopathology, and molecular testing complicates early diagnosis and often leads to unnecessary surgical exploration. Objective: This case report aims to describe the diagnostic pathway of a patient with epididymal tuberculosis whose clinical and sonographic findings closely mimicked epididymal malignancy at a hospital with limited diagnostic resources, and to review the diagnostic performance of available laboratory, radiological, and histopathological modalities. Methodology: This study used a descriptive case report design combined with a narrative literature review. Data were collected retrospectively from the patient's history, physical examination, Doppler ultrasonography, chest radiograph, intraoperative findings, and histopathological examination, and were analyzed using a descriptive-narrative approach supported by a literature search of PubMed/NCBI and Scopus. Findings: A 66-year-old man presented with a unilateral scrotal mass and weight loss without constitutional tuberculosis symptoms or prior tuberculosis history. Doppler ultrasonography showed an irregular, hypoechoic, hypervascular lesion with calcification, raising suspicion for malignancy; CT and MRI were unavailable. Surgical exploration revealed a localized mass at the cauda epididymis with a normal testis, and incision yielded thick caseous pus. Histopathology confirmed granulomatous inflammation with central caseous necrosis, epithelioid cells, and Langhans giant cells. The patient improved significantly on anti-tuberculosis therapy. Implications: This case emphasizes that epididymal tuberculosis should remain part of the differential diagnosis of a scrotal or epididymal mass even in the absence of classic constitutional symptoms, and that diagnostic strategy must be adapted to locally available resources. Originality: This report illustrates a diagnostic dilemma in which sonographic findings strongly suggested malignancy, yet the final diagnosis relied entirely on intraoperative and histopathological findings, highlighting the practical limits of imaging-based diagnosis in a low-resource setting.
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