Relapse of Wegener's granulomatosis presenting as a destructive urethritis and penile ulceration

Ebo, Didier G.; Mertens, A. V.; Clerck, Luc S. De; Gentens, P.; Daelemans, R.

doi:10.1007/bf01451056

Cited by 11 publications

(4 citation statements)

References 22 publications

(20 reference statements)

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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 . There have been a few case reports of GPA involving the bladder and presenting as bladder vasculitis .…”

Section: Differential Diagnosismentioning

confidence: 85%

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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Section: Differential Diagnosismentioning

confidence: 85%

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

Jimenez

Psutka

Stone

et al. 2016

Arthritis Care & Research

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“…In other cases, they appear before subsequent development of pulmonary involvement of GPA or as a symptom of GPA relapse [79,81]. Symptomatic urogenital manifestations in case reports with concomitant lung involvement included prostatitis [79,82], epididymitis [79,81], renal mass [79], ureteral stenosis [82], and penile ulceration [83][84]. Some presentations, such as a renal or prostate mass, mimic cancer or an abscess.…”

Section: Urogenital Manifestations Of Gpamentioning

confidence: 99%

Atypical Manifestations of Granulomatosis with Polyangiitis: The Diagnostic Challenge for Pulmonologists

Szymanowska-Narloch

Gawryluk²,

Błasińska‐Przerwa³

et al. 2020

Advances in Respiratory Medicine

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This is a review considering atypical manifestations of granulomatosis with polyangiitis (GPA). Virtually any organ can be affected, and in some patients, GPA can manifest unusually. Since thoracic involvement of GPA often predominates, the first who might be expected to establish a diagnosis are pulmonary specialists. We would like to familiarize pulmonary specialists with several extra-ELK (E: ear-nose-throat; L: lung; K: kidney) involvements of the disease. We describe sites rarely affected by GPA like the breast, skeletal system, orbit and eye, heart and vessels, central nervous system, urogenital system as well as endocrine and gastrointestinal tract involvement.

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“…Mucosal involvement is uncommon and occurs usually in the form of oral ulcers and gingival hyperplasia whereas genitalia are rarely affected [1] . Among the few cases of WG with penile ulceration [2][3][4][5][6][7][8][9][10][11][12] , at least 7 revealed the disease, including the two recent reports [2][3][4][5][6][7][8] . Mucocutaneous lesions may be an early premonitory sign while active systemic disease can be delayed several years.…”

mentioning

confidence: 99%

“…Urethral involvement can be associated with penile ulceration in WG [2,7,11] . However, urogenital involvement could be more severe: epididymitis, urethritis, prostatitis and complete disappearance of the corpus cavernosum have been described in association to penile necrosis [7] .…”

mentioning

confidence: 99%