Chronic Epididymitis Secondary to <i>Mycobacterium tuberculosis</i> Complex After Intravesical Bacillus Calmette-Guérin Therapy for Bladder Cancer

Intravesical Bacillus Calmette-Guérin immunotherapy for nonmuscle invasive bladder cancer reduces recurrence and progression. However, it carries a risk for dissemination and underrecognized complications, such as tuberculous epididymitis. A 68-year-old man with a history of nonmuscle invasive bladder cancer developed scrotal pain and swelling after completing Bacillus Calmette-Guérin therapy. Initial work-up, including urinalysis and culture, were negative, but acid-fast bacilli culture confirmed Mycobacterium tuberculosis complex infection. The patient was effectively treated with isoniazid, rifabutin, and ethambutol without requiring surgical intervention. Scrotal symptoms following therapy suggest Bacillus Calmette-Guérin-related complications. Treatment regimens are tailored to account for inherent resistance of Mycobacterium bovis to pyrazinamide.