Glans Penis Ulceration Revealing Wegener’s Granulomatosis

Bories, N.; Becuwe, C.; Marcilly, Marie-Cécile; Wolf, François; Balme, B.; Thomas, Logan

doi:10.1159/000098583

Cited by 15 publications

(9 citation statements)

References 14 publications

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“…Involvement of the male urogenital system with WG occurs in about 10% of patients and mainly affects the prostate . Although the scrotum, testis, bladder, urethra, epididymis and penis can occasionally involved .…”

Section: Urogenital System Involvementmentioning

confidence: 99%

Wegener's granulomatosis: a review of clinical features and an update in diagnosis and treatment

Almouhawis

Leão

Fedele

et al. 2013

J Oral Pathology Medicine

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Wegener's granulomatosis (WG) is an idiopathic, systemic inflammatory disease characterized by necrotizing granulomatous inflammation and pauci-immune small-vessel vasculitis of upper and lower respiratory tract and kidneys. The condition affects both genders equally, although some inconsistent gender differences have been observed. The aetiology of WG remains unknown although a number of exogenous factors have been suggested to be of aetiological relevance. Most clinical characteristics of this disease are non-specific, making clinical diagnosis challenging. Histopathological examination of lesional and peritoneal tissue is not pathognomonic, but is an essential investigation to confirm the presence of disease and exclude other disorders. At present, despite the increasingly wide range of potential therapies, cyclophosphamide plus corticosteroids remain the most recognized and effective means of inducing and sustaining remission of WG.

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Section: Urogenital System Involvementmentioning

confidence: 99%

Wegener's granulomatosis: a review of clinical features and an update in diagnosis and treatment

Almouhawis

Leão

Fedele

et al. 2013

J Oral Pathology Medicine

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“…Many case reports have also shown GPA to be associated with erosive, painful genital and penile ulcerations . Urethral involvement has also been described, which could explain this patient's symptoms of dysuria .…”

Section: Differential Diagnosismentioning

confidence: 67%

“…Urogenital involvement can be extensive and severe, presenting as epididymitis, urethritis, prostatitis, and ultimately leading to penile necrosis . Seventeen cases of severe ureteral or urethropenile involvement have been previously described.…”

Section: Discussionmentioning

confidence: 99%

“…GPA is a necrotizing granulomatous vasculitis that can affect virtually any organ, with a special predilection for the upper respiratory tract, lungs, and kidneys . Urogenital GPA, including involvement of the prostate, seminal vesicles, testis, epididymis, bladder ureters, urethra, retroperitoneum, cervix, vagina, perineum, and penis have all been reported .…”

Section: Differential Diagnosismentioning

confidence: 99%

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A 53‐Year‐Old Man With Dysuria, Pyuria, and Genital Ulcers

Jimenez

Psutka

Stone

et al. 2016

Arthritis Care & Research

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A 53-year-old man with dysuria, pyuria, and genital ulcers. History of the present illnessThe patient developed dysuria and pain at the base of the penis 1 month before presenting to an outside hospital. His pain worsened and he developed fever, pyuria, and penile ulcers a couple of days prior to admission. The patient also noted light pink urine, which was concerning for hematuria. He was treated empirically for both chlamydia and herpes simplex virus (HSV) infections with doxycycline and acyclovir, respectively, but urine polymerase chain reaction assays for Chlamydia trachomatis and Neisseria gonorrhea were negative and a penile ulcer swab was negative for HSV. His diagnosis was amended to prostatitis and he was discharged on levofloxacin. Amoxicillin was added after his urine culture grew a group B Streptococcus species.He followed up in the urology clinic as an outpatient and underwent a transrectal ultrasound of the prostate, the results of which were not consistent with prostatitis. A computed tomographic scan of the pelvis with contrast demonstrated mild thickening of the bladder wall and perivesical stranding consistent with inflammation. He continued to have painful urination and pyuria, for which he was readmitted to the hospital 3 weeks later.During his second hospital admission, he underwent repeat cystoscopy that revealed a large necrotic mass at the bladder trigone. The mass obstructed both ureteral orifices. Transurethral resection of the trigonal mass was performed, with bilateral ureteral stent placement. Histologic examination of the surgical specimen was notable for acute suppurative inflammation and necrosis, without evidence of malignancy.Ulcerative lesions on the glans penis persisted. These were retested for HSV as well as for Lymphogranuloma venereum and Treponema pallidum, but all of these assays were negative. He was prescribed a topical glucocorticoid, which seemed to decrease the size of the ulcers.During his admission, his serum creatinine rose from baseline of 1.2 to 4.0 mg/dl. His acute kidney injury was attributed to the combination of contrast-induced renal injury and obstructive uropathy from his resected trigonal mass. His creatinine improved but did not normalize following placement of ureteral stents. He developed a fever to 1018F and was started on piperacillin and tazobactam with no clear genitourinary source of infection. An extensive serologic evaluation demonstrated that the patient was negative for rheumatoid factor, antinuclear antibodies (ANAs), cyroglobulins, human immunodeficiency virus infection, hepatitis A, B, and C, and anti-neutrophil cytoplasmic antibodies (ANCA). The serum angiotensinconverting enzyme concentration was normal. Cultures of his penile lesion grew few yeast, but were otherwise unremarkable. The patient was then transferred for further evaluation.The patient was admitted to the urology service with diagnoses of obstructive uropathy by a bladder mass of unknown etiology, pelvic pain, and penile ulcers. Examination of the urine sediment revealed n...

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“…Clinically it might be misdiagnosed as erosive pustular dermatosis of the scalp [11] or as herpes zoster, particularly if mainly the parietal branch of the temporal artery is affected. Also Wegener's granulomatosis can lead to skin ulcerations [12][13][14] . In conclusion, we strongly recommend skin biopsies in patients with recalcitrant scalp necrosis when virus detection (varicella-zoster virus) and aciclovir treatment fail and an elevated ESR as well as accompanying symptoms like headache and dysphagia are present, to determine whether the patient suffers from giant cell arteritis.…”

Section: Discussionmentioning

confidence: 99%