Penile paraffinoma: A rare but important presentation

Abstract

A 30-year-old Bulgarian man presented with a 7-day history of a painful, pruritic penile swelling and 3-days of penile shaft ulceration and necrosis. The glans was unaffected (Figure 1). He reported no history of penile discharge, lower urinary tract symptoms, trauma, STI or penile cancer. Observations were normal. Inflammatory markers were mildly raised, syphilis and HIV serology were negative. Genital swabs grew only normal skin flora and mixed anaerobes. MRI confirmed superficial involvement only (Figure 2(a) and (b)). His current employment was picking daffodils, and as this appeared to involve superficial structures he was treated for severe penile daffodil rash 1 with antibiotics, emollients and topical steroids under the guidance of dermatology and genitourinary medicine. Punch biopsy of the penile shaft showed predominantly granulation tissue with numerous inflammatory cells and paraffin deposits (Figure 3). At a 2-week clinic review, he admitted injecting paraffin into his penis four and eight years previously, to achieve penile augmentation. Although the swelling and erythema had settled, the area of ulceration remained. He was therefore diagnosed with penile paraffinoma and referred for reconstructive surgery, but returned to Bulgaria before this was possible.

Letter to the editor re: Penile paraffinoma: A rare but important presentation. A Gaukroger et al. J Clin Urol 2018; DOI: 10.1177/2051415818806064

“…We read with interest the recent publication by Gaukroger et al 'Penile parafinnoma: A rare but important presentation'. 1 A case is presented of a 30-year-old Eastern European male who presented with a week-long history of painful penile swelling, followed by a three-day course of shaft ulceration and necrosis. Following a differential diagnosis of Daffodil picker's rash, a punch biopsy demonstrated granulation tissue.…”

“…We read with interest the recent publication by Gaukroger et al ‘Penile parafinnoma: A rare but important presentation’. 1…”