Rare testicular and spermatic cord involvement with concurrent inguinal hernia: a diagnostic enigma in relapse of lepromatous leprosy

Summary Granulomatous orchitis and spermatic cord infiltration are exceptionally rare complications of lepromatous leprosy, posing significant diagnostic challenges. This case report describes a middle-aged male from coastal South India with relapse leprosy presenting with granulomatous orchitis, spermatic cord infiltration, and a right-sided indirect inguinal hernia. The patient reported swelling in the right groin for six months, loss of libido, and redness of the eyes. A secondary finding of central serous chorioretinopathy was identified during ophthalmological evaluation. Slit-skin smear studies revealed a bacterial index of 6+, and histopathology confirmed the diagnosis of lepromatous leprosy. Multibacillary multidrug therapy was initiated as per national guidelines, leading to clinical improvement. This case highlights the importance of recognizing systemic manifestations of leprosy, distinguishing them from other granulomatous conditions, and ensuring multidisciplinary management in endemic regions.