Genitourinary Tuberculosis Presenting As Testicular Malignancy and Resulting in Tuberculous Autonephrectomy

Genitourinary tuberculosis is a common form of extrapulmonary tuberculosis and may mimic malignancy and chronic bacterial infection, leading to delayed diagnosis and irreversible organ damage. We report a case of genitourinary tuberculosis in a 41-year-old man presenting with chronic epididymal inflammation, a testicular mass, and progressive hydronephrotic destruction of the left kidney. Imaging findings initially raised suspicion for testicular malignancy. Histopathological examination following orchifuniculectomy demonstrated extensive necrotising granulomatous inflammation without evidence of malignancy, while acid-fast bacilli were not identified. Molecular testing of urine samples detected Mycobacterium tuberculosis complex deoxyribonucleic acid (MTBC DNA), and one of several mycobacterial urine cultures subsequently yielded positive growth for Mycobacterium tuberculosis. Imaging demonstrated destructive changes of the left kidney and mild bilateral apical pulmonary lesions compatible with tuberculosis, while sputum and bronchial aspirate microscopy, culture, and Xpert Mycobacterium tuberculosis and Rifampicin (MTB/RIF) testing (Cepheid, Sunnyvale, USA) remained negative. Anti-tuberculosis treatment was initiated. Because of complete functional loss and extensive parenchymal destruction, laparoscopic nephrectomy was required. Histopathological examination of the nephrectomy specimen confirmed necrotising granulomatous inflammation consistent with renal tuberculosis. This case highlights the diagnostic challenges of genitourinary tuberculosis, which is frequently associated with nonspecific symptoms and low mycobacterial load, and emphasises the importance of combining radiological, histopathological, molecular, and microbiological findings.