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Atypical testicular pain
  1. Nishant Bedi1,
  2. Muhammad Naim Che Rahimi1,
  3. Sarah Menzies2 and
  4. Jas Kalsi1
  1. 1 Urological Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Frimley, UK
  2. 2 Respiratory medicine, Frimley Health NHS Foundation Trust, Frimley, UK
  1. Correspondence to Nishant Bedi, nishantbedi{at}


Testicular tuberculosis (TB) is rare, and, because of this, the lack of pathognomonic clinical features and its tendency to mimic other commoner conditions, the diagnosis is frequently delayed or may be missed. In this case, the initial clinical presentation was typical for bacterial epididymo-orchitis in a 38-year-old man. When the patient failed to improve with standard treatment including broadening of antibiotics, the diagnosis was re-considered because some unusual signs suggested testicular malignancy or lymphoma. Further, history-taking and subsequent cross-sectional imaging with CT/MRI identified co-existent pulmonary nodularity, thoracic and abdominal lymphadenopathy and bony changes that, together, raised the suspicion of TB. Mycobacterium tuberculosis was confirmed on DNA-based testing of the hydrocele fluid, although standard acid-fast bacilli culture was negative. This case prompted a review of the literature to explore the optimal steps in the investigation and diagnosis of this rare disease.

  • urinary tract infections
  • urology
  • urological surgery
  • tuberculosis
  • TB and other respiratory infections

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  • Patient consent for publication Obtained.

  • Contributors All authors contributed to this article. NB was lead author of the manuscript. Concept and discussion: NB, SM and JK. MNCR data acquisition and assistance with drafting the manuscript. SM revised the manuscript and the TB learning points. JK revised the draft manuscript and the urological learning points.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.