Chronic Epididymo-Orchitis Mimicking Tuberculosis Turned Out to be Leprosy: A Case Report

Abstract

The causes of chronic orchitis and Epididymo-orchitis are varied including, urinary tract infection (UTI), gonococcal or nongonococcal (chlamydia, ureaplasma) infections, genitourinary tuberculosis (GUTB), post-vasectomy and drug-induced. However, the Urology textbooks do not mention leprosy as a differential diagnosis in such cases [1]. Herein, we present a case of Epididymoorchitis caused by leprosy with a review of the literature. Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Leprosy affects mainly the skin and peripheral nerves. Its diagnosis is established on the skin and neurologic examination of the patient. Involvement of testis and epididymis is well described in dermatology literature with an incidence ranging from 23.6% to 68.3% [2,3]. Testicular involvement is more in lepromatous leprosy and may result in infertility and impotence. However, practicing urologist does not keep this condition as a differential diagnosis and many such cases might remain undiagnosed. There are several classification systems validated for leprosy. The most commonly used Ridley & Jopling classification system (1966) is based on the concept of spectral leprosy and uses clinical, immunological, and histopathological criteria [4]. The spectrum consists of tuberculoid form at one end and the lepromatous form at the other end. The borderline form is divided into borderline-tuberculoid, borderlinelepromatous, according to the greater proximity to one of the poles, and borderline-borderline. Multi-Drug Therapy is the cornerstone of the treatment of leprosy.