Could Mycoplasma genitalium be involved in chronic granulomatous orchiepididymits? Case report and literature review.

Rev Esp Quimioter 2023;36(1): 103-106 103 to anatomic pathology for study and a 1.6 x 1.1 cm lesion of yellowish-white coloration and necrotic-purulent appearance was observed. Microscopically (Figure 2), a necrotizing, impaling and exudative granulomatous lesion was observed, while in the rest of the epididymis chronic inflammatory changes with suppurative flare-up and images of spermatogenic granuloma of long evolution were observed. Grocott, Ziehl and Warthin-Starry techniques (which can detect fungi, mycobacteria and Helicobacter pylori or spirochetes, respectively), together with immunohistochemical markers for germinal lesion (OCT-4 and SALL-4), as well as PLAP, D2-40 and CK AE1-AE3, were negative. DNA eluate was obtained using the Cobas© DNA Sample Preparation Kit panel (Roche Diagnostics, Basel, Switzerland) from the lesion to perform PCR of Mycobacterium tuberculosis using the GenoType Mycobacteria Direct panel (Hain Lifescience, Nehren, Germany), which allows us, by amplification of 23S rRNA, the detection of M. tuberculosis Complex, Mycobacterium avium, Mycobacterium intracellulare, Mycobacterium kansasii and Mycobacterium malamoense, with negative results. The STI Essential Assay AllpexTM panel (Seegene, Seoul, South Korea) that detects 7 pathogens related to sexually transmitted infections (Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, Neisseria gonorrhoeae, Trichomonas vaginalis, Ureaplasma parvum and Ureaplasma urealyticum) was also performed, detecting M. genitalium with Ct (cycle threshold) values of 21. A semen sample was sent 1 month after this study and the STI Essntial Assay Allplex© panel again detected M. genitalium, but this time with Ct values of 33. In addition, the ResistancePlus© MG FleXible panel was performed on the GeneXpert system (Cepheid, California, USA), which detects both M. genitalium and macrolide resistance mediated by mutations in the 23S rRNA gene, with detection of the microorganism, but without detection of the mutation.