Ogbole et al. Journal of Medical Case Reports 2011, 5:100 http://www.jmedicalcasereports.com/content/5/1/100 Page 3 of 5 Figure 3 Photomicrograph (hematoxylin and eosin stain; low- power view original magnification, ×16) of the testicular biopsy showing the testicular tissue extensively replaced by tuberculosis-induced chronic necrotizing granulomatous inflammation (black arrow) with only a few seminiferous tubules preserved (white arrow). edema and multiple punctate enhancing hyperintense lesions in the periventricular regions and at the gray- white matter junction in both cerebral hemispheres con- sistent with tuberculomas (Figure 4a, b). He achieved significant clinical improvement on ATT and was fol- lowed up at the outpatient clinic. A six-month follow- up MRI scan showed only a solitary ring-enhancing mass in the left frontoparietal region with complete resolution of all other lesions and perilesional edema (Figure 4c). He had no complaints, and there were no observable neurological deficits. Discussion Testicular tuberculosis is an unusual presentation of genitourinary tuberculosis affecting only 7% of patients with tuberculosis [10] and is usually associated with dis- eases in other parts of the body, such as the urinary tract, abdomen and lungs. In cases where there is no clear history of a primary disease or disseminated or other secondary diseases, testicular tuberculosis presents a diagnostic dilemma, and more often than not the cor- rect diagnosis is made on the basis of postoperative his- tological samples [8]. The ultrasound features of testicular tuberculosis vary from a solitary hypoechoic mass simulating a seminoma to multiple hypoechoic masses such as nonseminomatous testicular cancer as in our patient. This diagnostic pitfall is unavoidable in the absence of other complementary diagnostic tools such as serum LCD and b-human chorionic gonadotropin which are usually raised [8]. In our patient, the puzzling features of testicular tuberculosis were compounded by Figure 4 T2-weighted axial magnetic resonance imaging (MRI) scans (a, b) showing extensive area of hyperintensity in the left frontoparietal region and multiple oval hyperintense lesions in both parietooccipital regions close to the vertex. (c, d) T2- weighted and T1-weighted postgadolinium axial MRI scans obtained six months Post-therapy show solitary ring-enhancing tuberculoma in the left frontoparietal region with resolved edema. the neurological symptoms of intracranial tuberculomas, which made the diagnosis of testicular tumor with intra- cranial metastases more likely and was readily embraced by the managing physicians. A similar line of manage- ment was reported in the literature with solitary tuber- culous epididymoorchitis masquerading as a testicular tumor [8]. CNS tuberculosis has been in existence as long as tuberculosis itself. It is also endemic in Africa and other regions of the world, and recently the preva- lence of tuberculosis has risen worldwide with the dis- ease burden being compounded by HIV/acquired immunodeficiency syndrome (AIDS) cases [11]. Miyamoto et al. [12] reported spinal intramedullary and intracranial tuberculomas in a patient with pulmon- ary and testicular disease; however, to the best of our knowledge, there has been no report of testicular tuber- culosis with metastatic spread to the brain alone. Since prompt diagnosis of brain tuberculomas may result in early treatment and a better prognosis for the patient, recognition of this disorder on the basis of imaging may play a critical role in patient management [13]. When brain tuberculomas are associated with meningitis, the diagnosis is more apparent and appropriate therapy can be readily instituted [14]. However, therapy may be delayed when the tuberculoma gives rise to neurological