Hydrocele as initial manifestation of genitourinary and miliary tuberculosis

Abstract

Introduction. Tuberculosis is an infectious disease that can affect any organ in the body, including the genitourinary system, which accounts for 33.7 - 45.5 % of non-pulmonary tuberculosis cases. The purpose of this paper is to report a case of hydrocele as initial manifestation of genitourinary and miliary tuberculosis, which was an unsuspected disease. Case Presentation. Previously healthy male patient is admitted to emergencies due to orchialgia and bilateral hydrocele, with purulent secretion from the scrotum. Was managed with intravenous antibiotic and right hydrocelectomy. Intraoperative findings of thickening of right epididymis and drainage of caseous and purulent material. Ipsilateral epididymectomy was performed; testing for detection of tubercle bacillus in specimen and purified protein derivative was requested, and was found positive. In the postoperative period, respiratory symptoms arose; paraclinical tests found compromised lungs, pleura and urinary tract by tubercle bacillus. Antituberculous treatment was initiated with satisfactory evolution. Discussion. The genitourinary system is the second-most affected system by nonpulmonary tuberculosis. The most affected organ is the kidney (by 80 % compared to the others) and the most affected genital organ is the epididymis (22 - 55 %). It should be suspected in patients with chronic urinary symptoms with no apparent cause. It is associated with a high rate of morbidity and mortality due to infertility and kidney failure. Conclusions. Despite the non-specific symptoms and because it is not normally a suspected entity, genitourinary tuberculosis should be ruled out when pulmonary tuberculosis exists. Timely diagnosis and treatment are very important in order to prevent secondary complications.