Two rare genitourinary tuberculosis presentations with isolated testicular and tubo-ovarian tuberculosis in resource limiting setups: A case report and review of literature.

Introduction And Importance: Tuberculosis (TB), a common chronic infectious disease, affected approximately 10.6 million people worldwide in 2021. While TB can affect the lungs (pulmonary TB) or other parts of the body, extrapulmonary TB, genital TB is a rare form of extrapulmonary TB. Within genital TB, isolated testicular TB is uncommon; representing only 2-4 % of genitourinary TB cases, and ovarian TB is also infrequent in females.

Case Presentation: Two patients from the Gerbo region of Somalia and Ethiopia presented with: a 65-year-old man with a 10-month history of left scrotal swelling and mild pain, and a 40-year-old multiparous pregnant woman with a 5-day history of acute abdominal pain and distension resulting in abortion. Neither patient reported chronic comorbidities or cough. The male patient was stable with normal initial investigations, while the female patient presented with fever and ascites. Diagnosis was confirmed by histopathological examination and AFB staining in the male patient and a positive GeneXpert test on intra-abdominal fluid in the female patient. Both patients received anti-tuberculosis treatment (2RHZE/4RH), resulting in complete recovery.

Clinical Discussion: Despite global efforts, tuberculosis remains a leading cause of death worldwide, disproportionately impacting low-socioeconomic populations. Genitourinary tuberculosis (GUTB), representing 30-40 % of extrapulmonary TB cases (second only to lymph node involvement), commonly affects the kidneys and fallopian tubes. Isolated testicular and tubo-ovarian tuberculosis are rare forms of GUTB. Immunocompromise increases the risk of genital TB, although neither of our patients exhibited such conditions. Genital TB presents variably depending on sex and affected organs. Diagnosis relies on isolating Mycobacterium from various samples and histological findings. Guideline-directed anti-tuberculosis therapy typically cures the infection without surgery.

Conclusion: Genital tuberculosis requires a high index of suspicion for accurate diagnosis, particularly in resource-limited settings. Effective anti-tuberculosis treatment often suffices, minimizing the need for surgery.