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A case of scrotal sarcoidosis that mimicked tuberculosis

Nature Clinical Practice Urology volume 4, pages 227–230 (2007)Cite this article

Abstract

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.

Investigations 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.

Diagnosis 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.

Management 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.

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Figure 1: Ultrasound scan of testicle that shows multiple, hypoechoic lesions present within the testicular body
Figure 2: Photomicrograph of testicular biopsy specimen
Figure 3: Photomicrograph of epididymal biopsy specimen that shows a high-power view of an epithelioid granuloma with incipient central necrosis

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Authors and Affiliations

  1. SN Datta is a Research Registrar at the National Hospital for Neurology and Neurosurgery, London, A Freeman is a Consultant Histopathologist at University College Hospital, London, CN Amerasinghe is a Senior Consultant Pathologist at Ealing and Central Middlesex Hospitals, and TP Rosenbaum is a Consultant Urological Surgeon at Ealing Hospital, West London, UK.,

    Soumendra N Datta, Alex Freeman, Cyril N Amerasinghe & Tomas P Rosenbaum

Authors
  1. Soumendra N Datta
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  2. Alex Freeman
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  3. Cyril N Amerasinghe
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  4. Tomas P Rosenbaum
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Correspondence to Soumendra N Datta.

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The authors declare no competing financial interests.

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Datta, S., Freeman, A., Amerasinghe, C. et al. A case of scrotal sarcoidosis that mimicked tuberculosis. Nat Rev Urol 4, 227–230 (2007). https://doi.org/10.1038/ncpuro0777

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