Drug-Resistant Tuberculosis Presenting as a Testicular Mass: A Case Report

Abstract

Anti-microbial resistance is a growing threat to the effective treatment of various pathogens.1 In particular, drug-resistant tuberculosis (DR-TB) is the leading contributor to antimicrobial resistance-related death globally, with only a 55% treatment success rate reported globally.2 The global prevalence of multidrug-resistant tuberculosis (MDR-TB) continues to rise and is of public health concern. In 2019 alone, there were about half a million new cases of rifampicin-resistant tuberculosis (RR-TB), of which about 80% had MDR-TB.3 Extrapulmonary tuberculosis (EPTB), which is tuberculosis outside the lung parenchyma, constitutes 10–15% of all tuberculosis cases among HIV-negative adults and 60% in HIV-infected.4 Extrapulmonary drug-resistant tuberculosis is extremely rare and constitutes 5% of DR-TB.5 This is attributed to the low numbers of Mycobacterium tuberculosis present in the tissue and the inadequate diagnostics, especially in limited-resource settings.6 Genitourinary tuberculosis is one of the late manifestations of what was initially pulmonary tuberculosis infection. While cases of testicular and scrotal DR-TB have been described before, they are extremely rare, and there is no consensus on the appropriate management. One hospital-based cross-sectional in Uganda showed that approximately 10% (7 out of 73) of the patients presenting with testicular pain had tuberculous epididymo-orchitis.7 Here, we describe a case of a middle-aged HIV seronegative male with testicular RR-TB, who had no evidence of pulmonary involvement.