Isolated testicular tuberculosis a differential diagnosis for testicular mass: Frequently missed diagnosis

Abstract Tuberculosis leading to infertility in men is rarely diagnosed as urogenital TB in males has a varied nonspecific presentation in the form of oligospermia, azoospermia, and persistent urinary infection, and rarely as painless scrotal mass. We present a case of Azoospermia who on evaluation was found to have retrograde ejaculation and isolated left testicular enlargement. On Scrotal Ultrasound (USG) Left testis had a lobulated heterogenous nonvascular mass measuring 48 mm × 37 mm obliterating the testicular architecture and the Epididymis was normal. Tumor markers were normal. Patient underwent Left orchidectomy and sperm freezing for future fertility. To our surprise histopathological examination was suggestive of tuberculosis (TB). Patient was given antitubercular treatment. We are presenting our case as isolated testicular involvement in TB is rare. It is usually associated with obstructive azoospermia, typically without distended seminal vesicle, but our case had azoospermia due to retrograde ejaculation giving rise to a diagnostic dilemma and double trouble for the patient.