The tissue examination of left testis and epididymis showed chronic granulomatous epididymitis and granulomatous orchitis (Figures 5, 6, 7). The acid-fast stains showed numerous acid fast positive bacilli (Figure 8), which were consistent with tuberculosis. The Gram and Grocott stains were negative for bacteria and fungi.
Histopathologic examination of tissue from the left wrist and the distal radial/ulnar joint revealed granulomatous tenosynovitis with focal necrotizing granulomas (Figure 9). Rare acid fast bacilli were identified on Ziehl-Neelsen and Auramine-O acid fast stains. The Grocott stains were negative for fungal organisms.