This report is of a patient with isolated tuberculous epididymitis presenting with a scrotal tumor. A 65-year-old man presented with a rapidly growing, painless mass over his right testicle. A non-tender indurated tumor was identified in the right hemi-scrotum. Digital rectal examination detected a moderately enlarged, elastic prostate that was consistent with benign prostatic hyperplasia. Urinalysis was normal without pyuria. Complete blood count, biochemistry, prostate specific antigen, alpha-fetoprotein, and beta-human chorionic gonadotropin were all within normal levels. Chest X-ray was clear. Scrotal ultrasonography and computed tomography scan showed a tumor in the right testicle involving the epididymis with hydrocele, but the renal images were normal. The diagnosis was right epididymo-testicular tumor. The right testis was removed. Postoperative pathology showed tuberculous epididymitis. Subsequent urine mycobacterial culture was negative. The patient had an uneventful postoperative course. The patient was treated with standard 9-month triple anti-tuberculosis medications, and remained stable at follow-up.