Granuloma of Epididymis in a Patient Treated with Intravesical BCG Therapy—Complication of BCG Therapy or Tuberculosis?

We present a case of a 72-year-old man treated for superficial bladder carcinoma from the year 2007. The patient underwent a surgical intervention for transitional cell carcinoma of the bladder, followed by intravesical BCG immunotherapy. Two years later, the right testis and epididymis were found to be enlarged. A resection was carried out. Histological examination revealed granulomatous infiltration with eosinophillic necrosis in cauda epididymis. No bacteriologic tests of the resected material were performed. Due to a suspected BCG infection or TB, the patient was transferred to the Institute of Tuberculosis and Lung Diseases in Warsaw, for pulmonary evaluation. Chest X-ray, chest CT scan and bronchoscopy were performed but apart from scars in the bronchi suggesting a history of TB, they did not contribute to the diagnosis. Tuberculin skin test was 21 mm. Diagnosis was determined by spoligotyping which found genetic material of Mycobacterium tuberculosis in specimens preserved in a paraffin block. Tuberculosis of the right epididymis and past pulmonary tuberculosis were diagnosed. The patient was treated with rifampin, isoniazid and pyrazynamid.