Rare case of gangrene of penis in a patient with chronic kidney disease on dialysis

Abstract

Gangrene of the penis in patients with chronic kidney disease undergoing haemodialysis is a rare occurrence. Such patients often have associated comorbidities such as type II diabetes mellitus and systemic hypertension, along with secondary hyperparathyroidism leading to dystrophic calcification. These conditions accelerate the process of atherosclerosis, which, along with calcium deposition, causes partial or complete obstruction of the blood vessel lumen, leading to ischaemic necrosis at the tip of the penis. This adds to the pre-existing morbidity and mortality in such patients. In most cases, appropriate medical management is advocated to prevent the deposition of calcium in the lumen.

Penile necrosis by calciphylaxis leading to gangrene in a patient with chronic renal failure on dialysis: A case report

“…In previously reported cases [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ] ( Table 1 ), all patients including the present case had chronic kidney disease (78% were reported on dialysis) and diabetes mellitus which could be a predisposing factor [ 16 ]. Seven reported cases, including our patient’s case, had a high blood pressure and two of them had a long history with smoking [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ]. In our case, other risk factors were found such as obesity and anticoagulant treatment that may worsen pre-existing atherosclerosis.…”

“…In our case, the histopathological diagnosis of calciphylaxis shows diabetic microangiopathy that is accompanied by vascular calcification of both the tunica intima and media of blood vessels with intimal fibroblastic proliferation. In other cases [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ], the histopathological diagnosis was performed in 6 patients including our case and 8 patients who received at least one radiological assessment. In our case, the patient received an arteriography that showed multiple vascular calcifications at the level of the internal iliac artery and its branches.…”

“…The survival was higher in patients who had undergone partial penectomy (37.5%) than in those treated with total penectomy (12.5%). Endovascular revascularization [ 9 ] and conservative treatment [ 14 ] appeared to play an important role in the penile’s wound healing.…”

Cutaneous calciphylaxis of the glans penis presenting as a gangrenous ulceration

“…Penile involvement is a rare distal manifestation of calciphylaxis; it manifests with black eschars and necrosis mimicking a wound [13][14][15]. Our case suggests that mucosal necrosis may have a moist and whitish appearance.…”