Xanthogranulomatous epididymitis is an extremely rare disease. Its etiology is unclear, but it is characterized by chronic suppurative granulomatous inflammation. We report on a 53-year-old diabetic man who suffered from left scrotal swelling and pain. Because the condition did not improve with the use of antibiotic therapy, left orchiectomy was performed. Pathological examination revealed a xanthogranulomatous epididymitis.