Granulomatous Epididymo-Orchitis, A Rare Complication of Bacillus Calmette-Guerin Immunotherapy for Bladder Cancer: A Case Report

Abstract

Granulomatous epididymo-orchitis (GEO) is a rare disease characterized by granulomatous inflammation due to etiologies such as infection with mycobacteria. A well-known mycobacterial infection, Mycobacterium tuberculosis (M. tb) which causes tuberculosis (TB), can disseminate from the lungs to infect other organs. However, a mycobacterial infection in the genitourinary system without clinical evidence of TB is unusual. A 79-year-old man with nonmuscle invasive papillary urothelial carcinoma (PUC) was treated with chemotherapy and Bacillus Calmette-Guerin (BCG) immunotherapy, a live-attenuated strain of Mycobacterium bovis (M. bovis). One year later, he developed an epididymal cyst on the left testicle and an enlarged left epididymis. A simple left orchiectomy was performed. Microscopic examination showed granulomas within the testicular and epididymal parenchyma. Ziehl-Neelsen (AFB) stain revealed scattered acid-fast bacilli. The positive AFB stain raised the possibility of TB infection. However, the patient had no clinical evidence of latent or active TB, family history of TB, or TB treatment in the past. Here, we present a rare case of GEO, not caused by TB, but by BCG, a live-attenuated strain of M. bovis.

[N A J Med Sci. 2024;17(1):008-010.   DOI:  10.7156/najms.2024.1701008]

Key Words: granulomatous epididymo-orchitis, bacillus calmette-guerin (BCG),

Mycobacterium bovis, complication of BCG, tuberculosis (TB)