A 41-year-old man in Morocco presented to the Ibn Sina University Hospital with an alarming symptom: an eight-week history of scrotal swelling, culminating in his left testicle reaching a diameter of 15cm and leaking a thick, milky fluid. The medical team diagnosed him with genitourinary tuberculosis (GUTB), a rare form of TB impacting the genitals and urinary tract. While TB typically affects the lungs, it can spread to other organs, making GUTB a less common but serious manifestation of the disease. This case highlighted the diagnostic challenge of extrapulmonary TB, as the patient lacked the typical respiratory symptoms associated with the disease.
Tuberculosis, considered one of the deadliest infectious diseases globally, surpassed COVID-19 as the leading cause of death from an infectious agent in 2023. The endemic nature of TB in Morocco, with an incidence rate of 97 cases per 100,000 people annually, contributed to the context of this patient’s diagnosis. The recent resurgence of TB in the UK and other parts of the world underscores the continued threat posed by this ancient disease. While pulmonary TB remains the most common form, extrapulmonary TB, encompassing cases where the infection affects areas outside the lungs, accounts for a significant portion of cases. GUTB represents a subset of these extrapulmonary cases, further highlighting the diverse ways TB can manifest.
The patient’s lack of typical TB symptoms, such as fever, cough, night sweats, or weight loss, initially masked the underlying cause of his testicular swelling. Normal chest X-rays further complicated the diagnostic picture, ruling out the most common presentation of the disease. The absence of a history of TB exposure or other urinary symptoms, coupled with the localized nature of the swelling, added to the complexity of the case. Physical examination revealed the firm, irregular, and non-tender nature of the affected testicle, contrasting with the normal appearance of the right testicle.
Imaging studies played a crucial role in confirming the diagnosis. Ultrasound showed a thickened scrotal wall with infiltration of surrounding tissues. A CT scan revealed the absence of TB involvement in the bladder and kidneys, localizing the infection to the testicle. Given the potential for malignancy or further spread of the infection, the medical team decided to surgically remove the affected testicle. The surgical findings corroborated the diagnosis, revealing a grossly enlarged testicle with a necrotic and heterogeneous appearance.
Following the surgical intervention, the patient underwent a six-month course of anti-TB medication. He tolerated the treatment well without significant side effects. However, follow-up testing revealed a devastating consequence of the infection: permanent impairment of fertility due to the absence of sperm in his semen. This unfortunate outcome underscores the potential long-term impact of GUTB and highlights the importance of timely diagnosis and treatment. While TB is treatable with a six-month course of antibiotics, adherence to the full treatment regimen is essential to prevent relapse and further complications.
This case serves as a reminder of the diverse manifestations of tuberculosis and the importance of considering TB in the differential diagnosis of unusual genitourinary presentations. The challenging diagnostic process, coupled with the potential for serious long-term sequelae, underscores the need for heightened awareness and vigilance among healthcare professionals. The global resurgence of TB, alongside the increasing prevalence of drug-resistant strains, emphasizes the continuing need for public health measures to control the spread of this deadly disease. The patient’s experience also serves as a testament to the importance of seeking medical attention for unusual or persistent symptoms, as early diagnosis and treatment are critical for mitigating the potentially devastating consequences of tuberculosis.
