摘要

A 51-year-old man presented with painless left testicular swelling for 1 month, with fevers, chills, night sweats, weight loss, and increased difficulty voiding over 6 months. He underwent radical orchiectomy; surgical pathology revealed granulomas containing acid-fast bacilli in the testis and epididymis. Male genital tuberculosis was diagnosed using nucleic acid amplification on urine and confirmed by positive urine and sputum cultures for Mycobacterium tuberculosis. Genital disease is an unusual extrapulmonary manifestation of tuberculosis, often seen in middle-aged men with renal or pulmonary tuberculosis. Clinical findings are variable, but commonly include dysuria with sterile pyuria or a painless testicular mass. Initial diagnosis is often incidentally made on pathological specimens and confirmed with nucleic acid amplification and cultures. Treatment using a standard four-drug regimen is usually sufficient; surgery is rarely required. This case is used to raise awareness of, and formulate a minimally invasive diagnostic approach to, this unusual but important entity.

译文

一名 51 岁的男性出现无痛左睾丸肿胀 1 个月，伴有发烧、发冷、盗汗、体重减轻和超过 6 个月排尿困难增加。他接受了睾丸切除术; 手术病理显示睾丸和附睾中含有抗酸杆菌的肉芽肿。使用尿液核酸扩增诊断男性生殖器结核，并通过尿液和痰培养结核分枝杆菌阳性确诊。生殖器疾病是一种不寻常的肺外结核病表现，常见于患有肾脏或肺结核的中年男性。临床结果各不相同，但通常包括排尿困难伴无菌脓尿或无痛睾丸肿块。初始诊断通常是在病理标本上偶然进行的，并通过核酸扩增和培养来确认。使用标准的四种药物方案治疗通常是足够的; 很少需要手术。这个病例被用来提高对这个不寻常但重要的实体的认识，并制定一个微创诊断方法。