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CASE REPORT |
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| Year : 2000 | Volume
: 16
| Issue : 2 | Page : 165-166 |
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Spontaneous penile skin gangrene in AIDS
Mallikarjuna N Reddy, A Thyagi, D Sharma, VSNL, Eashwar K Goud
Department of Genito-Urinary Surgery, Osmania General Hospital, Hyderabad, India
Correspondence Address:
Mallikarjuna N Reddy
Department of Genito-Urinary Surgery, Osmania General Hospital, Hyderabad, Andhra Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
 Abstract | | |
AIDS is a systematic infection of retrovirus causing immunodeficiency. Many varied manifestations of the disease have been reported. Systemic vasculitis has been reported in as one of the manifestations of the syndrome. This has resulted in areas of skin necrosis in varied parts of 'the body. We report a case of penile skin necrosis which occurred spontaneously in a 25-year-old male patient with no evidence of trauma or infection.
Keywords: Penis; AIDS; Gangrene.
How to cite this article:
Reddy MN, Thyagi A, Sharma D, VSNL, Goud EK. Spontaneous penile skin gangrene in AIDS. Indian J Urol 2000;16:165-6 |
| Introduction | |  |
Presence of skin necrosis has been documented in AIDS. The cause was attributed to vasculitis or anti-phospholipid antibodies in the serum. None of them have reported spontaneous penile skin necrosis. Most of the spontaneous penile skin necroses were a part of Fournier's gangrene.
| Case Report | | |
A 25-year-old male patient presented to our outpatient department with loss of the skin over the penis. There was no history of trauma or in terms of sexual activity or application of tourniquet or any erogenous devices. He had developed generalized lymphadenopathy and presented with black skin hanging loose from the penis and the penis having slough on the exposed surface [Figure 1]. There was no foul smell suggestive of infection and the patient was voiding normally from the urethra. Investigations of the patient showed that his renal parameters and the blood counts to be under normal limits. His CD4 counts were <200 cells/cumm, he was positive for western blot for AIDS. Urine culture was sterile. Slough over the penis and the sloughed skin did not grow any organisms on both aerobic and anaerobic cultures. Histopathology of the sloughed skin showed necrosis with minimal inflammatory infiltrate and no organisms were seen.
| Discussion | | |
On exhaustive review of literature in the Internet there were no reports of spontaneous skin necrosis available. Cases of penile skin necrosis have been documented as part of Fournier's gangrene. Skin necrosis in AIDS was also reported by Soweid AM et al in South Med J and the cause for the necrosis was due to anti-phospholipid antibodies. Reports of penile calciphylaxis have been reported and the cause was tertiary hyperparathyroidism in chronic renal failure. 10 cases of distal penile gangrene was reported in patients with chronic renal failure. [1],[2],[3],[4],[5],[6] Cutaneous gangrene due to hyperparathyroidism secondary to chronic renal failure were reported. A case of penile necrosis with extensive Kaposi's sarcoma was reported by Klein et al. The presentation is surprisingly only skin involvement of the penile skin with no extension into the underlying tissues with no evidence of trauma or infection.
| References | | |
| 1. | Stein M, Anderson C, Ricciardi R et al. Penile gangrene associated with chronic renal failure: report of 7 cases and review of the literature. J Urol 1994; 152: 2014-2016.  |
| 2. | Atalay AC, Karaman MI. Distal penile gangrene in a patient with chronic renal failure. Int J Urol 1997; 4: 431-432. [PUBMED] |
| 3. | Jhaveri FM, Woosley JT, Fried FA. Penile calciphylaxis: rare necrotic lesions in chronic renal failure patients. J Urol 1998; 160: 764-767. [PUBMED] |
| 4. | Wilkinson SP, Stewart WK, Parham DM, Guthrie W. Symmetric gangrene of the extremities in late renal failure: a case report and review of the literature. Q J Med 1988; 67: 319-341. [PUBMED] [FULLTEXT] |
| 5. | Soweid AM. Hajjar RR, Hewan-Lowe KO. Gonzalez EB. Skin necrosis indicating antiphospholipid syndrome in patient with AIDS. South Med J 1995; 88: 786-788. |
| 6. | Klein LT, Lowe FC. Penile gangrene associated with extensiveKaposi's sarcoma in patients with the acquired immunodeficiency syndrome. Urology 1995; 46: 425-428. [PUBMED] [FULLTEXT] |
[Figure 1]
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