Rajabi Mohammad Hassan, Ahmadi Gharaei Hasan, ArabAhmadi Ali, Yarmohammadi Mobina
Department of Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Department of Health, Faculty of Public Health, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
Caspian J Intern Med. 2021 Winter;12(1):111-114. doi: 10.22088/cjim.12.1.111.
Extrapulmonary tuberculosis accounts for only 15% of new cases of tuberculosis. In extrapulmonary tuberculosis, usually affected areas include bone, pleura, lymph nodes, genitourinary system, joints, peritoneum and meninges. Tuberculosis epididymo-orchitis is an uncommon type of extrapulmonary tuberculosis.
We reported a case of tuberculosis epididymo-orchitis and involvement of the left testicle in a 37-year-old male patient. The left testicle had a heterogeneous parenchymal echo, and multiple hypo-echo and ill-defined areas were evident in the left testicle. In the color Doppler ultrasound, the left testicle with the epididymis on both sides was completely hyperemic. The findings were primarily in the favor of extrapulmonary tuberculosis. Therefore, after a 2-month first-stage treatment with four-drug therapy of anti-TB drugs such as rifampin 150 mg, isoniazid 75 mg, pyrazinamide 400 mg and ethambutol 275 mg, considering the weight of the patient (56 kg), 4 pills per day and the second phase with two-drug therapy, rifampin 150 mg and 75 mg of isoniazid, 4 pills per day for 4 months, extrapulmonary tuberculosis symptoms improved to a large extent.
To prevent epididymectomy and the effects that the disease may have on fertility, it should be tried to quickly diagnose and treat the disease at the same early stage of the disease.
肺外结核仅占新发结核病病例的15%。在肺外结核中，通常受累的部位包括骨骼、胸膜、淋巴结、泌尿生殖系统、关节、腹膜和脑膜。附睾睾丸炎是一种罕见的肺外结核类型。
我们报告了一例37岁男性患者的附睾睾丸炎及左侧睾丸受累情况。左侧睾丸实质回声不均匀，左侧睾丸内可见多个低回声及边界不清的区域。在彩色多普勒超声检查中，双侧附睾及左侧睾丸均完全充血。这些表现主要支持肺外结核。因此，在采用利福平150毫克、异烟肼75毫克、吡嗪酰胺400毫克和乙胺丁醇275毫克等抗结核药物进行为期2个月的四联药物治疗的第一阶段，考虑到患者体重（56千克），每日4片，以及第二阶段采用利福平150毫克和异烟肼75毫克的二联药物治疗，每日4片共4个月后，肺外结核症状有了很大改善。
为防止附睾切除术以及该疾病可能对生育能力产生的影响，应在疾病早期尽快尝试对其进行诊断和治疗。
