Abstract
Tuberculosis (TB) continues to pose a major health challenge worldwide, particularly in regions where the disease is endemic, such as India. Although the lungs are the most commonly affected, TB can also involve other organs, including the genitourinary system. Testicular involvement is extremely uncommon and can clinically resemble more frequent scrotal conditions like pyocele or epididymo-orchitis. We present the case of a 50-year-old male who developed unilateral scrotal pain and swelling, initially suggestive of an acute infection. Emergency scrotal exploration uncovered an abscess with necrotic testicular tissue. Histopathological examination confirmed testicular tuberculosis. The patient responded well to anti-tuberculous treatment, emphasizing the need to include TB in the differential diagnosis of atypical scrotal swellings, especially in endemic areas.