2017 Resarch Forum

IM: C-8

Applicant & Principal Investigator: Benson Lee DO

Extrapulmonary tuberculosis presenting as a painful testicular mass Benson Lee DO, Shahab Hillyer MD, Bethany Ann Citerella MS IV, Arash Heidari MD

INTRODUCTION

Dissemination to the epididymis is a relatively rare and underdiagnosed presentation of extrapulmonary tuberculosis. PURPOSE The primary purpose is to describe an atypical clinical presentation, workup, diagnosis and management of male genital tuberculosis presenting as a painful testicular mass. DISCUSSION Mycobacterium Tuberculosis (MTB) is a relatively rare infection in the United States with substantial decline since 1992, falling to a historic low of 2.9 per 100,000 in 2014. Nevertheless, it is still an important cause of infectious disease deaths worldwide, only behind that of HIV. A majority of cases reported in the United States are immigrants from endemic countries which poses a challenge for infectious disease control. Urogenital tuberculosis is the second most common extrapulmonary manifestation of tuberculosis in endemic countries and the third most common in countries with low incidence. In developed, countries, approximately 2-10% of patients with pulmonary tuberculosis also have dissemination to the urogenital system. Of those with urogenital tuberculosis, isolated genital involvement appears to be rare. This 48 year-old Hispanic male patient originally from Mexico, presented with a left painful testicular mass that did not resolve with multiple course of antibiotics. He also had a negative urinalysis and urine cultures for infection. It is important to note that, he had prior exposure to Isoniazid resistant tuberculosis and underwent treatment with Rifampin for latent tuberculosis, which poses another challenge of possible infection with multi- drug resistant TB. This patient eventually underwent surgical resection of his left epididymis, with tissue pathology, stains and cultures positive for MTB. He was started on direct observation therapy with rifampin, isoniazid, pyrazinamide and ethambutol (RIPE). Genital tuberculosis can be confused for malignancy and bacterial causes. It is important to identify this presentation of tuberculosis owing to the highly contagious nature and potential for morbidity and mortality. CONCLUSION Genital tuberculosis is a rare and underdiagnosed manifestation of extrapulmonary tuberculosis and requires a high index of suspicion in patients with relevant risk factors.