Recurrent penile ulcer as a manifestation of chronic lymphocytic leukaemia

Abstract

Sir: I read with interest the audit by Murray and Jones on bloodborne virus (BBV) services in Her Majesty's Prison Service that reported on hepatitis C virus (HCV) infections among female inmates. 1 Their findings are comparable to what have been reported with high prevalence of HCV infection among those with intravenous drug use (IVDU). 2,3 IVDU is now becoming the leading cause of HCV transmission. In our local setting, IVDU accounts for more than half of the aetiology for HCV infection and this is increasing as transmissions through haemodialysis and contaminated blood products are decreasing. All our incarcerated inmates are screened at entry for BBVs (HIV, hepatitis B, HCV and syphilis) and HCV infection represent the most common infection detected.The audit highlighted the importance of screening inmates for BBVs and the opportunities provided. There are several advantages for provision of such services. Screening helps to identify infected individuals who otherwise would not have presented themselves voluntarily for testing and would remain undetected and undiagnosed. HCV infection is a major public health problem and this is especially true in rehabilitation or correctional facilities due to the large pools of undiagnosed infections and high-risk behaviours. Undetected cases will place other inmates or even facilities staff at risk. Family members will also be at risk when inmates are released. In our local setting, family members of identified cases are offered screening. Identifications of infections allow for counselling and education on risk behaviour modifications. Treatment can be considered as treatment for IVDUs whether active or rehabilitated have been shown to be as effective as non-IVDUs. 4,5 Our own experience showed that treatment responses (sustained viral response) to standard combination therapy were comparable (IVDU, 64.7% versus non-IVDU, 63.6%, P ¼ ns). 4 Treatments during incarceration provide the assurance of compliance, which is an important predictor of response to therapy. Importantly, a large proportion of the inmates in our local setting remained rehabilitated once released. Therefore, the period of incarceration provides opportunities to rehabilitate, counsel, educate and treat those infected. As such, I believed such screening programme should be introduced to all correctional or rehabilitation facilities and even made compulsory as treatments are available. Furthermore, from the public health point of view, it helps to identify the groups of patients who contribute largely to the pools of HCV-infected persons. Parry JV. Prevalence of antibodies to hepatitis B, hepatitis C and HIV and risk factors in Irish prisoners: results of a national cross sectional survey. BMJ 2000;321:78 -82 3 Crofts N, Stewart T, Hearne P, Ping XY, Breshkin AM, Locarnini SA. Spread of blood-borne viruses among Australian prison entrants. Br Med J 1995;310:285-8 4 Chong VH, Jamaludin AZ, Jacob AP, Jalihal A. Treating intravenous drug users with hepatitis C infection: an opportunity in some settings. Eur...

An unusual, delayed, solitary manifestation of a penile lesion in chronic lymphocytic leukemia

“…[ 4 ] Primary cancers metastasizing to the penis include prostate, bladder, colon, and kidneys, however, penile involvement by CLL is extremely rare. [ 5 ] The penile metastasis clinically presents as either penile nodules, skin lesions, or as malignant priapism, but presentation as a solitary penile lesion is rare. [ 6 ] Some investigators propose that retrograde lymphatic spread could explain the infiltration of the foreskin and superficial fascia.…”