Primary Isolated Testicular Tuberculosis in an Elderly Male: A Rare Case Report from Sekadau General Hospital as Rural Accessibility

Abstract

Introduction: Pulmonary tuberculosis represents the predominant clinical manifestation of tuberculosis. Extra-pulmonary involvement accounts for approximately 10–15% of cases, with lymph nodes being the most frequently affected site in Asian. Presentation of Case:  A 60‑year‑old male presented with a painful, right-sided testicular swelling without any discharging sinus or scrotal ulceration for 1 month. There was no history of any respiratory symptom. On examination, the general survey revealed no abnormality, Ultrasonography examination of testes showed the right side of scrotum was enlarge (3.38 x 3.34 x 5.0 cm) sized heteroechoic space occupying lesion with hypoechoic components and small cystic areas were seen at the lower pole of the right testis, lobulated with clear line, On Color Doppler Ultrasound (CDUS) showed intralesional vascularization. For the left side was within normal range. From Ultrasonography (USG) examination concluded that Solid mass with cystic component in right testes, suggestive for malignancy with hydrocele on the right side, with normal of left testes.  The patient was informed to surgery procedure such as orchiectomy. Discussion: Tuberculosis (TB) remains one of the leading causes of mortality worldwide, particularly in developing countries within TB-endemic regions such as Indonesia. Among these, isolated genital involvement is observed in nearly 28% of patients with genitourinary TB and occurs more frequently in males. Scrotal ultrasonography plays a pivotal role in the evaluation and diagnosis of tuberculous orchitis. Standard anti-tubercular chemotherapy remains the cornerstone of treatment for tuberculous orchitis. A six-month regimen consisting of rifampicin, isoniazid, pyrazinamide, and ethambutol during the intensive phase for two months, followed by rifampicin and isoniazid for an additional four months, is generally effective in achieving complete resolution of testicular lesions. Surgical intervention is reserved for selected cases with complications or poor response to medical therapy. Conclusion: Primary isolated testicular tuberculosis is an uncommon clinical entity and is frequently underrecognized because of its nonspecific presentation. Consequently, a high index of suspicion supported by thorough history taking, detailed physical examination, and appropriate diagnostic investigations is essential.