While sarcoidosis affecting the testicles is rare, it can be a cause of infertility in men, according to a new case report.
The report, “Sarcoidosis is a rare cause of infertility: A case report,” was published in Urology Case Reports.
Sarcoidosis is characterized by the formation of abnormal lumps of inflammatory cells — known as granulomas — in different organs.
The lungs are most commonly affected, but any organ can be involved. However, involvement of genital and urinary organs (urogenital sarcoidosis) is rare. Testicular problems are also rare in urogenital sarcoidosis patients. In fact, only about 60 cases testicular dysfunction due to sarcoidosis have been reported.
This report presents the case of a 31-year-old man who came to a clinic in Turkey with complaints of infertility.
Physicians performed a thorough physical examination, and found that while both testicles were normally shaped and had adequate volume, a sperm analysis showed azoospermia (semen containing little or no sperm).
The man underwent several laboratory tests to assess tumor markers and hormones such as prolactin, testosterone, and estradiol. Laboratory test results were found to be normal.
A scrotal ultrasonography (USG) — imaging of the testicles and the surrounding area of the scrotum — found differences in both testicles. So physicians conducted a scrotal magnetic resonance imaging (MRI), which showed hypoechoic areas (meaning areas with solid mass) in the testicles.
Since the patient had recurrent cough for three weeks, a chest X-ray was taken and revealed the presence of immune cells in the lungs.
As physicians suspected the patient had sarcoidosis, they performed HRCT (high-resolution computed tomography), an imaging technique commonly used to diagnose sarcoidosis.
HRCT results revealed widespread fibrotic changes (when tissue becomes damaged and scarred) in both lungs. The patient was referred to a pulmonary disease clinic where he underwent further diagnostic tests, but no malignancy nor Mycobacterium tuberculosis infection was detected.
Physicians then performed an open testicular biopsy to collect a small tissue sample from the testicles, which revealed the presence of numerous granulomas covering the entire parenchyma (functional tissue of an organ).
As these findings were compatible with a diagnosis of sarcoidosis, the man was placed on oral steroid therapy.
He responded to the treatment within six months, and lesions (granulomas) within the lungs and testicles resolved within three months. One year later, the patient was able to have a child without the use of assisted reproductive techniques.
“Although testicular sarcoidosis is a rare condition, it may result in infertility. Therefore, clinicians should carefully investigate infertility patients with unknown etiology [origin] and systemic symptoms. After excluding the malignancies, sarcoidosis should be kept in mind” as a potential diagnosis, the researchers concluded.
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