A Rare Case of Scrotal Tuberculosis Mimicking Malignancy- A Case Report

A 23-year-old male presented with a history of a painless, bleeding ulcer over the left side of the scrotum for four months and bilateral inguinal ulcers for three months with watery discharge. He was a defaulter case of pulmonary TB, diagnosed two years back. There was a history of on-and-off fever for 4 months and significant weight loss. No loss of appetite or cough. On examination, there was an ulceroproliferative growth of 5×5×4 cm over the base of the left side of the scrotum. On palpation, the lesion was tender, bleeding to touch with undermined edges and an indurated base. The left testis and epididymis were not separately palpable. The left spermatic cord was normal. The right testis and spermatic cord were normal. There was ulcerated bilateral inguinal lymphadenopathy with serous discharge. Upon inspection, the patient was cachectic. There were no palpable abdominal tumours, and the abdomen was soft. A chest radiograph taken of the patient revealed no localised lung lesions. An ill-defined, heterogenous, hypoechoic extra-testicular mass in the left scrotum was seen on a scrotal ultrasound, along with a mass lesion in the left scrotal sac that included the scrotum and several enlarged bilateral inguinal, left iliac, aortocaval, and paraaortic lymph nodes. A wedge biopsy from the scrotum showed a granulomatous lesion (possibly tubercular). FNAC of bilateral inguinal nodes showed features of granulomatous lymphadenitis. Sputum CBNAAT detected rifampicin-sensitive Mycobacterium tuberculosis. The patient was started on antitubercular therapy and responded well to treatment and is on the path to recovery.