Right Acute Epididymo-orchitis Masquerading as Prostate Tuberculosis: A Case Report

Abstract

Introduction: Prostatic tuberculosis (TB) is a rare manifestation of extrapulmonary TB, often diagnosed incidentally due to its nonspecific presentation. This case highlights the diagnostic and management challenges of prostatic TB in a young, immunocompetent patient. Case Presentation: A 28-year-old previously healthy man presented with acute right testicular pain and swelling, initially diagnosed as epididymo-orchitis. Despite empirical antibiotic therapy, symptoms persisted. Contrast-enhanced CT revealed bilateral prostatic abscesses and a small intraperitoneal collection. Transurethral drainage was performed, and intraoperative samples confirmed TB via acid-fast bacilli detection and histopathology showing necrotising granulomatous inflammation. Anti-TB therapy was initiated, resulting in clinical improvement and radiological resolution of collections. Discussion: Prostatic TB should be considered in young patients from endemic regions presenting with atypical genitourinary infections unresponsive to antibiotics. Imaging modalities such as CT or TRUS are crucial in identifying prostatic abscesses. Early diagnosis and initiation of anti-TB therapy are essential to prevent complications. Conclusion: Prostatic TB remains an uncommon and under-recognized entity. High clinical suspicion, especially in TB-endemic regions, and early imaging are critical for diagnosis and effective management.