A case of scrotal sarcoidosis that mimicked tuberculosis.
BACKGROUND
A 38-year-old man presented with bilateral testicular swelling, night sweats and weight loss with little response to antibiotics. Examination revealed systemic lymphadenopathy and multiple small masses arising from both testes.


METHODS
Scrotal ultrasound revealed multiple intratesticular, hypoechoic lesions; chest radiograph and abdominal ultrasound were normal. A CT scan revealed multilevel lymphadenopathies. A Heaf (tuberculin) skin test was negative. Testicular biopsy revealed multiple granulomata, some of which showed patchy central necrosis.


METHODS
A diagnosis of tuberculosis was initially made. After 3 months of clinical deterioration despite antitubercular drug therapy, however, the diagnosis was changed to sarcoidosis because blood results revealed hypercalcemia, elevated serum angiotensin-converting enzyme, and an elevated erythrocyte sedimentation rate.


RESULTS
The patient improved dramatically on corticosteroid therapy, with complete regression of all testicular lesions on imaging after 2 months. Steroids were tapered, then discontinued after 6 months. The patient remained in complete remission, but became oligospermic by the 3 year follow-up.
Datta
Soumendra N
SN
National Hospital for Neurology and Neurosurgery, London, UK. snd999@gmail.com
Freeman
Alex
A
Amerasinghe
Cyril N
CN
Rosenbaum
Tomas P
TP
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D018570:Risk Assessment; D012507:Sarcoidosis / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D012611:Scrotum / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014401:Tuberculosis, Urogenital / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D018608:Ultrasonography, Doppler
D000305:Adrenal Cortex Hormones; D000995:Antitubercular Agents