Ogbole et al. Journal of Medical Case Reports 2011, 5:100 http://www.jmedicalcasereports.com/content/5/1/100 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Testicular tuberculosis presenting with metastatic intracranial tuberculomas only: a case report Godwin I Ogbole1*, Oku S Bassey1, Clement A Okolo2, Samson O Ukperi1, Ayotunde O Ogunseyinde1 Abstract Introduction: Intracranial tuberculomas are a rare complication of tuberculosis occurring through hematogenous spread from an extracranial source, most often of pulmonary origin. Testicular tuberculosis with only intracranial spread is an even rarer finding and to the best of our knowledge, has not been reported in the literature. Clinical suspicion or recognition and prompt diagnosis are important because early treatment can prevent patient deterioration and lead to clinical improvement. Case presentation: We present the case of a 51-year-old African man with testicular tuberculosis and multiple intracranial tuberculomas who was initially managed for testicular cancer with intracranial metastasis. He had undergone left radical orchidectomy, but subsequently developed hemiparesis and lost consciousness. Following histopathological confirmation of the postoperative sample as chronic granulomatous infection due to tuberculosis, he sustained significant clinical improvement with antituberculous therapy, recovered fully and was discharged at two weeks post-treatment. Conclusion: The clinical presentation of intracranial tuberculomas from an extracranial source is protean, and delayed diagnosis could have devastating consequences. The need to have a high index of suspicion is important, since neuroimaging features may not be pathognomonic. Introduction The incidence of tuberculosis (TB) has recently increased significantly worldwide, primarily because of the human immunodeficiency virus (HIV) pandemic. Controlling multidrug resistance with this surge is a major public health concern [1]. Tuberculosis remains the leading cause of death worldwide because of a single infectious agent, killing approximately two million people in one year [2,3]. Hematogenous spread to the central nervous system (CNS) and other organs may occur early in the course of infection, and 15% to 20% of extrapulmonary tuberculosis involves the CNS [4]. CNS involvement manifests as meningitis, cerebritis, tuberculous abscesses or tuberculomas, with incidence varying from one region to another [1]. Before the advent of modern neuroima- ging modalities (computed tomography (CT) and mag- netic resonance imaging (MRI)), the incidence of CNS tuberculosis in Ibadan, a southwestern Nigerian town [5], was estimated at 12.5%. Intracranial tuberculomas, * Correspondence: gogbole@yahoo.com 1Department of Radiology, University College Hospital, Ibadan, Nigeria Full list of author information is available at the end of the article however, are uncommon, accounting for about 0.2% of intracranial space-occupying lesions [6]. The radiologic features are nonspecific, however, and hence are difficult to diagnose without a proper medical history and a high index of suspicion [7]. We describe a case of a patient with testicular tuberculosis with multiple intracranial tuberculomas who was HIV-seronegative and was initi- ally managed for testicular cancer with intracranial metastases. Case presentation A 51-year-old African man was referred from a private facility with a two-month history of painless scrotal swelling and a one-week history of headache, drowsiness, incoherent speech, altered sensorium and low-grade pyr- exia. He had no history of cough, breathlessness, weight loss, trauma or urethral discharge. He was known to have hypertension of two years’ duration. An examination revealed marked enlargement of the left hemiscrotum, and the right hemiscrotum was also mildly enlarged. The testes were firm to hard in consistency, but there was no associated tenderness. Neurological examination revealed © 2011 Ogbole et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.