Yogesh Kumar Sarin, Meghna Kinjalk, Kiran Agarwal, Neha Jamwal
Xanthogranulomatous orchitis (XGO) represents an extremely uncommon form of destructive granulomatous inflammation of the testis, very sparingly documented in pediatric age groups. The clinical picture often mimics chronic epididymo-orchitis, ischemic testicular injury, or even malignant neoplasms, which makes timely diagnosis challenging and frequently delays definitive intervention. We present the case of a 12-year-old boy with nearly 1 year of recurrent urinary tract infections and persistent scrotal symptoms, repeatedly misinterpreted as inflammatory orchitis on ultrasonography. A radionuclide perfusion scan revealed complete absence of blood flow within the affected testis, confirming nonviability and warranting orchiectomy. Histopathology showed a classical xanthogranulomatous reaction composed of abundant foamy macrophages, multinucleated giant cells, inflammatory infiltrate, and areas of necrosis. The child underwent successful orchidectomy with delayed prosthetic testicular implant and remains asymptomatic during follow-up. This case reinforces the need to consider XGO as a differential diagnosis in children with chronic, nonresolving testicular inflammatory disorders and supports the role of perfusion scanning in guiding operative decision-making.