Penis Tuberculides: Papulonecrotic Tuberculides on the Glans penis

Abstract

Two cases of penis tuberculides are described. Although this disease once used to be comparatively common in Japan, the number of people affected by the disease has recently decreased as the prevalence of tuberculosis has fallen. However, we can still find a few cases in the Japanese literature every year. Outside Japan, we can hardly find reports of this disease, except for a few cases reported under the title of ‘Papulonecrotic tuberculides on the penis’ from Northern European countries. In addition to reporting 2 cases, we summarize clinical features of this disease. Racial predisposition or endemic factors may be related to the tuberculides in such a special site.

Tuberculid of the Glans Penis

“…This latter situation indicates that eases of exclusive genital lesions may represent a localized form ofthe same pathological process, but in our opinion it is a quite characteristic one, since most reported cases remain confined to the glans penis and most cases of PNT do not present with genital lesions. Genital ulcerative diseases usually considered as differential diagnosis with genital tuberculid include syphilis, recurrent herpes simplex, erythroplasia, drug eruption, balanitis, Behpet's disease and squamous cell carcinoma (7)(8)(9), and one of our patients had been pre- viously diagnosed with artifact balanitis for 20 years. To our knowledge no other disease, however, evolves into such a scar on the glans penis, and the cases presented herein are identieal to the photographs presented in previous reports (8, 9.…”

“…Mycobacteria cannot be cultured from lesions (10); nevertheless, some recent authors have found mycobacterial DNA in erythema induratum and PNT lesions using polymerase chain reaction (PCR) (3, 4. 10); and lesions show a good response to anti-tuberculous therapy (3,7,11,12). The occurrence of penile tuberculids is a very rare but well-documented event (3,5,(7)(8)(9).…”

“…10); and lesions show a good response to anti-tuberculous therapy (3,7,11,12). The occurrence of penile tuberculids is a very rare but well-documented event (3,5,(7)(8)(9). Most reports come from Japanese and South African authors (3,5,7,13), suggesting a racial or environmental predisposition, but occasional patients have been seen in other countries (8,9).…”

“…Clinical forms of tuberculids include erythema indurattim. papulo-necrotic tuberculid (PNT) and lichen scrofulosorum (1)(2)(3)(4)7). PNT occurs as multiple ulcerated papules and affects more commonly pilo-sebaceous follicle bearing areas of the skin, but, on rare occasions, palmopiantar and penile lesions have been reported.…”

The first reported case of tuberculosis of the glans penis in Sri Lanka

“…2 TB of glans penis presents as a superficial lesion which is difficult to differentiate from malignancy. 3 The glans penis can be involved primarily as an ulcerative lesion, by extension via the urethra or via haematogenous spread. 4 The standard six months course of anti TB drugs is sufficient to treat the disease.…”