Genital tuberculosis occurs in the epididymis most frequently but rarely involves the testis. Also, bilateral involvement of genital tuberculsis is rare. Diagnosis of tuberculous epididymitis and testicular involvement of tuberculosis can be challenging because they can be misdiagnosed as acute epididymitis and testicular tumor. Herein, we present a case of bilateral genital tuberculosis with unusual presentation which mimicked acute epididymitis and testicular tumor in a 72 year old male.