The patient first presented to the ultrasonography unit for assessment of parotid enlargement and the abdomen.

Neck ultrasound revealed bilateral symmetrical infiltration of both parotid glands with small hypoechoic pseudo-nodules, mostly representing lymphoid infiltration. The submandibular glands are much less affected. Abdominal ultrasound revealed mild hepatosplenomegaly and porta-hepatis lymphadenopathy.

Chest CT was requested that showed generalised mediastinal lymphadenopathies which were non-specific and minor pulmonary changes seen as scattered confluent pulmonary nodules, giving the "galaxy sign". It is most commonly described in sarcoidosis, but is also seen in tuberculosis, progressive massive fibrosis and even tumours. However, it favours a benign aetiology.

These findings mostly represent a multisystem disease. We first thought of sarcoidosis as a possibility. The internest requested video-assisted thoracoscopic surgery (VATS) biopsy from hilar and mediastinal lymph nodes and lung biopsy which revealed tuberculosis. He started antituberculous treatment.

Six months later, the patient presented with marked scrotal swelling. Ultrasound shows bilateral symmetrical epididymo-orchitis with marked bilateral hydrocele, suggestive of tuberculous epididymo-orchitis. The patient's general condition improved with antituberculous treatment, however, hepatosplenomegaly is still present with mild progression and porta-hepatis lymphadenopathies.