A case of scrotal sarcoidosis that mimicked tuberculosis

Nat Clin Pract Urol. 2007 Apr;4(4):227-30. doi: 10.1038/ncpuro0777.

Abstract

Background: A 38-year-old man presented with bilateral testicular swelling, night sweats and weight loss with little response to antibiotics. Examination revealed systemic lymphadenopathy and multiple small masses arising from both testes.

Investigations: Scrotal ultrasound revealed multiple intratesticular, hypoechoic lesions; chest radiograph and abdominal ultrasound were normal. A CT scan revealed multilevel lymphadenopathies. A Heaf (tuberculin) skin test was negative. Testicular biopsy revealed multiple granulomata, some of which showed patchy central necrosis.

Diagnosis: A diagnosis of tuberculosis was initially made. After 3 months of clinical deterioration despite antitubercular drug therapy, however, the diagnosis was changed to sarcoidosis because blood results revealed hypercalcemia, elevated serum angiotensin-converting enzyme, and an elevated erythrocyte sedimentation rate.

Management: The patient improved dramatically on corticosteroid therapy, with complete regression of all testicular lesions on imaging after 2 months. Steroids were tapered, then discontinued after 6 months. The patient remained in complete remission, but became oligospermic by the 3 year follow-up.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Antitubercular Agents / therapeutic use
  • Biopsy, Needle
  • Diagnosis, Differential
  • Humans
  • Immunohistochemistry
  • Male
  • Risk Assessment
  • Sarcoidosis / diagnosis
  • Sarcoidosis / drug therapy
  • Sarcoidosis / pathology*
  • Scrotum / pathology*
  • Tomography, X-Ray Computed
  • Tuberculosis, Urogenital / diagnosis
  • Tuberculosis, Urogenital / drug therapy
  • Tuberculosis, Urogenital / pathology*
  • Ultrasonography, Doppler

Substances

  • Adrenal Cortex Hormones
  • Antitubercular Agents