A 36-year-old immunocompetent male presented with a 2-month history of left testicular pain, swelling, and a palpable mass, initially misdiagnosed as epididymo-orchitis. Despite antibiotic treatment, symptoms persisted, leading to orchiectomy. Histopathological examination revealed granulomatous inflammation with acid-fast bacilli. Subsequent culture and whole-genome sequencing identified Mycobacterium tuberculosis, confirming extrapulmonary tuberculosis. The patient received a 6-month antitubercular regimen and recovered well. This case highlights the importance of considering extrapulmonary tuberculosis in atypical presentations of testicular masses, especially when initial treatments fail, and emphasizes the need for definitive microbiological diagnosis to guide appropriate therapy.
Key note: Extrapulmonary tuberculosis should be considered in cases of persistent testicular masses unresponsive to conventional antibiotics.