Tuberculous/BCG-Related Chronic Orchiepididymitis With Fistulization: Expanded Case Report and Literature Review

Intravesical Bacillus Calmette–Guérin (BCG) therapy is a well-established treatment for high-grade nonmuscle invasive bladder cancer. However, infectious complications such as granulomatous orchiepididymitis may rarely occur. We report a case of chronic necrotizing granulomatous orchiepididymitis with fistulization following intravesical BCG instillations. The patient presented with persistent epididymal swelling, caseous discharge, and inadequate response to conventional antibiotic therapy. Polymerase chain reaction (PCR) testing identified Mycobacterium tuberculosis complex. Despite clinical improvement under antituberculous therapy, surgical orchiectomy was required due to persistent anatomical destruction. Histopathological examination confirmed necrotizing granulomas with Langhans-type giant cells, consistent with bacillary orchiepididymitis.