Scrotal Abscess Revealing Epididymal Tuberculosis: A Case Report and Literature Review

Genitourinary tuberculosis is one of the most frequent forms of extrapulmonary tuberculosis and represents a significant health concern in endemic regions. Epididymal involvement is the most common manifestation of male genital tuberculosis. However, presentation as a scrotal abscess is uncommon and may lead to diagnostic confusion with other infectious conditions. We report the case of a 36-year-old man with no significant past medical or surgical history who presented with a two‑month history of progressive left scrotal pain associated with fever. The patient initially underwent drainage of a presumed scrotal abscess followed by conventional antibiotic therapy without clinical improvement. A second surgical exploration with debridement was required. Microbiological examination of pus revealed acid‑fast bacilli, while culture and polymerase chain reaction confirmed Mycobacterium tuberculosis. Histopathological examination of the excision specimen showed granulomatous inflammation with caseous necrosis, consistent with tuberculous infection. Epididymal tuberculosis should be considered in patients presenting with chronic scrotal abscess, particularly in tuberculosis‑endemic regions. Early microbiological investigation and appropriate anti‑tuberculous therapy are essential to avoid delayed diagnosis and complications.