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Tuberculosis of the genitourinary tract is a well-known cause of male infertility. However, infertility from infection by nontuberculous mycobacterium has not been reported. Herein, we present a case of seminal vesiculitis due to Mycobacterium gastri in a diabetic patient leading to male infertility. Improvement in semen quality was noticed after 6 months of therapy with isoniazid, ethambutol and rifampicin. Dr. S. Vaidyanathan, MS, MCh, MAMS, PhD, Associate Professor, Department of Urology, PGIMER, Chandigarh-160012 (India) Case Report MCG, a 31-year-old male patient presented at our Male Infertility Clinic for evaluation of primary infertility of 5 years duration. He had been a known diabetic on insulin for 8 years. He was treated for pulmonary tuberculosis (type of organism not known) with isoniazid, rifampicin and ethambutol 3 years ago. Physical examination was unremarkable except for right epididymitis. Apart from an ESR of 56 mm at the end of the 1st hour, routine biochemical and hematological investigations were normal. Semen analysis revealed a total sperm count of 26 millions/ml with over 90 % dead sperms and the remaining with distorted morphology. Urine and serum cultures were negative for routine aerobic and anaerobic bacteria. The urine culture grew Mycobacterium gastri at the end of 5 weeks, while semen culture did not reveal any acid-fast bacilli. Ultrasonogram (US) of the kidneys was unremarkable; however, US of the seminal vesicles revealed marked dilatation on both sides. Excretory uro-gram showed normal urinary system. Testicular biopsy revealed normal spermatogenesis. Left vasoseminal vesiculography showed no obstruction, but the seminal vesicle was dilated and tortuous. US-guided aspiration of the right seminal vesicle was done and contrast injected. CT scan taken following this revealed a dilated semiD ow nl oa de d by : 54 .7 0. 40 .1 1 10 /3 1/ 20 17 9 :0 3: 22 P M Fig. 1. CT scan of the pelvis after 6 days of US-guided contrast injection into the right seminal vesicle which is dilated and tortuous (a). The left seminal vesicle is also dilated (b). 100 Indudhara/Das/Sharma/Vaidyanathan 1.5 ml creamy white 180 mg % 18 millions, all of them dead 25–30/HPF 5–10/HPF no organism seen absent negative present for 5 weeks Table 1. Analysis of the seminal vesicle aspirate Amount Color Fructose Microscopy Total sperms Pus cells RBC Bacteriology Gram stain Acid-fast bacilli on smear Culture for aerobic and anaerobic organisms M. gastri on culture nal vesicle (fig. 1). The rest of the urinary tract was normal in the CT scan. The seminal vesicle aspirate characters are detailed in table 1. The aspirate yielded M. gastri after culture for 5 weeks. The patient was started on isoniazid, rifampicin and ethambutol, and at 6 months followup, his seminogram revealed a total count of 56 millions/ml, 30% with normal morphology and viability. Discussion Nontuberculous mycobacterial infections of the genitourinary tract are infrequently seen [1, 2]. M. kansasíi and M. avium-intracellulare have been attributed to renal infections [3–5]. M. xenopi and M. faznsαs/z’-induced epididymitis have also been reported [6, 7]. Granuloma-tous prostatitis associated with isolation of M. kansasíi was reported in a 31-year-old man from Omaha [8]. M. gordonnae, M. gastri, M. terrae-triviale and M. flaves-cans are grouped under atypical mycobacteria of little or no pathogenicity for man [3]. Urinary smears are notoriously D ow nl oa de d by : 54.70.40.11-10/31/20179:03:22PM unreliable for the diagnosis of genitourinary tuberculosis because of contamination from thelower end of the urethra. M. smegmatis is the traditional contaminant [3]. However, in thepresent case, M. gastri was grown both from the urine as well as the seminal vesicle aspirate; thelatter excludes any contamination from the urethral or proximal urinary system. The fact that thepatient had a radiologically demonstrable abnormality in the seminal vesicles with normalurinary tract further supports the contention that the M. gastri isolated from urine and seminalvesicle aspirate was responsible for the disease leading to infertility.The majority of the experience in the management of nontuberculous mycobacterial diseases hascome from the treatment of respiratory diseases, which constitute over 90% of the reportednontuberculous mycobacte-rioses [9]. No definite answers are available to several questionsrelating to the group of patients to be treated, the drugs to be used and the duration of treatment[3]. Hence, the risk-benefit ratio of drug therapy must be considered carefully and each caseneeds a meticulous, individualized approach.ReferencesFowler JE, Kessler R: Genital tract infection; in Lipshultz LI, Howards SS (eds): Infertility in theMale. New York, Churchill Livingstone, 1983, pp 283–298.Ross JC, Gow JG, Hill CA: Tuberculous epididymitis: A review of 170 patients. Br J Surg1961;48:663–666. Wolinsky E: Non-tuberculous mycobacteria and associated diseases. Am RevRespir Dis 1979;119:107–159. Pellman CM, Runyon EH: The significance of myocbacteriaother than tubercle bacilli in the urine: A report of 42 cases. Am Rev Respir Dis 1964;90:243–247.Pergament M, Gonzalez R, Fraley EW: Atypical mycobacterio-sis of the urinary tract. A casereport of extensive disease caused by the Battey bacillus. J Am Med Assoc 1974;229:816–817.Engbaek HC, Vergmann B, Baess I, Will DW: M. xenopi. A bacteriological study of M. xenopiincluding case reports of Danish patients. Acta Pathol Microbiol Scand 1967;69:576–594.Hepper NGG, Karlson AG, Leary FJ, Soule EH: Genitourinary infection due to Mycobacteriumkansasii. Mayo Clin Proc 1971; 46:387–390.Lee LW, Brugher LW, Price EB, Cassidy E: Granulomatous prostatitis. Association withisolation of Mycobacterium kansasii and Mycobacterium fortuitum. J Am Med Assoc 1977;237:2408–2409.O’Brien RJ, Geiter LJ, Snider DE: The epidemiology of nontuberculous mycobacterial diseasesin the United States. Results from a national study. Am Rev Respir Dis 1987;135:1007– 1014. Downloadedby: 54.70.40.11-10/31/20179:03:22PM