title: Tuberculids as sentinel lesions of tuberculous epididymo-orchitis.
abstract: BACKGROUND
  Tuberculids are rarely associated with male genital tract tuberculosis (TB). Tuberculous epididymo-orchitis (TBEO) has been associated rarely with papulonecrotic tuberculid (PNT) but not with erythema induratum (EI) or the simultaneous occurrence of different tuberculids.
  
  
  METHODS
  A retrospective assessment of tuberculids that occurred with underlying TBEO was carried out.
  
  
  RESULTS
  Five patients, four with one and one with two skin biopsies, with clinical diagnoses of PNT (two), EI (one), impetigo (two) and calf ulcer (one), formed the study cohort. Histopathological evaluation confirmed PNT and EI in four and two skin biopsies, respectively. Two patients who returned for follow-up were commenced on anti-tuberculous therapy. All patients sought medical attention 3-34 months later for tender right-sided (two) and left-sided (three) testicular masses. Orchidectomy was undertaken following a poor clinical response to empirical treatment with trimethoprim sulfamethoxazole. Pathological examination of the testis and epididymis confirmed TBEO. The patients were initiated on anti-tuberculous therapy. There was dramatic healing of the skin lesions.
  
  
  CONCLUSIONS
  Tuberculids are a sentinel cutaneous manifestation of visceral TB and a valuable external audit of treatment compliance and response. Heightened recognition of and more rigorous genitourinary tract investigation are necessary to identify occult or asymptomatic TBEO as the underlying cause of tuberculids.
authors.affiliation: Department of Pathology, Nelson R Mandela School of Medicine, University of KwaZulu Natal and National Health Laboratory Services, Durban, KwaZulu Natal, South Africa. ramdial@ukzn.ac.za
authors.forename: Pratistadevi K
authors.initials: PK
authors.lastname: Ramdial
authors.forename: Eduardo
authors.initials: E
authors.lastname: Calonje
authors.forename: Clive
authors.initials: C
authors.lastname: Sydney
authors.forename: Sumeshini
authors.initials: S
authors.lastname: Subrayen
authors.forename: Phumlani S
authors.initials: PS
authors.lastname: Meyiwa
authors.forename: Jamila
authors.initials: J
authors.lastname: Aboobaker
mesh_terms: D000328:Adult; D004823:Epididymitis / Q000382:microbiology* / Q000473:pathology*; D006801:Humans; D008297:Male; D009920:Orchitis / Q000382:microbiology* / Q000473:pathology*; D012189:Retrospective Studies; D014382:Tuberculosis, Cutaneous / Q000473:pathology*; D014389:Tuberculosis, Male Genital / Q000473:pathology*