1
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Ismy J, Khalilullah SA, Bahagianto AF. Case Report: Glans penile necrosis in a patient with SARS-CoV-2 and leprosy infection. F1000Res 2024; 11:142. [PMID: 39233873 PMCID: PMC11372346 DOI: 10.12688/f1000research.84355.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 09/06/2024] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was firstly identified in China and has been declared a global pandemic. Several serious extrapulmonary manifestations due to SARS-CoV-2 infection have also been reported and associated with hypercoagulability thrombotic vasculopathy. In addition, cases of Mycobacterium-leprae infection have also been known associated with blood coagulation abnormality. Methods Here, we report a 56-year-old male with coronavirus disease-19 (COVID-19) with concomitant leprosy infection with manifestation of glans penile necrosis, presented to the emergency department with acute penile pain. This case is unique because no occlusion blood flow to the penile was observed in the radiographic imaging. We described the potential pathophysiology in this case through a literature review. Results The patient received treatment according to the COVID-19 protocol and was given low molecular weight heparin (LMWH) therapy for 4 days. During the follow up, the clinical and functional condition of the penis showed significant improvement. Conclusions Microthrombus involvement, platelet abnormalities and impaired hemostasis due to SARS-CoV-2 and leprosy co-infection are the hypothesis in this case report.
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Affiliation(s)
- Jufriady Ismy
- Division of Urology, Department of Surgery, Dr. Zainoel Abidin General Hospital, Universitas Syiah Kuala, Banda Aceh, Aceh, 23230, Indonesia
| | - Said Alfin Khalilullah
- Division of Urology, Department of Surgery, Dr. Zainoel Abidin General Hospital, Universitas Syiah Kuala, Banda Aceh, Aceh, 23230, Indonesia
| | - Aditya Fajar Bahagianto
- Division of Urology, Department of Surgery, Dr. Hasan Sadikin General Hospital, Universitas Padjajaran, Bandung, Indonesia
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2
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Misakyan N, Abu-Shanab A, Shah S. Penile Calciphylaxis: A Successfully Treated Case. Cureus 2024; 16:e54824. [PMID: 38529436 PMCID: PMC10962866 DOI: 10.7759/cureus.54824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/27/2024] Open
Abstract
Penile calciphylaxis is a rare presentation of calcific uremic arteriolopathy and can be a life-threatening condition usually seen in patients with end-stage renal failure with hemodialysis. The clear etiopathogenesis of calciphylaxis is not fully understood, but it is postulated to be characterized by the accumulation of calcium in the microvessels of adipose tissue and skin, which leads to ischemia and necrosis, causing painful ulcerations, and could potentially be complicated by sepsis and mortality. End-stage renal disease (ESRD) is one of the major risk factors for penile calciphylaxis. In this report, we describe a case of a 53-year-old Hispanic male patient with ESRD and diabetes on hemodialysis, who presented with a five-day history of acute, severe, burning, non-radiating pain to the head of his penis associated with black discoloration. He was diagnosed with penile calciphylaxis and received a combination of conservative and surgical interventions, resulting in a highly positive outcome marked by complete healing of the scar without any reported complications.
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Affiliation(s)
- Narine Misakyan
- Internal Medicine, Capital Health Medical Center, Trenton, USA
| | - Amer Abu-Shanab
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Shazia Shah
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
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3
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Wipattanakitcharoen A, Takkavatakarn K, Susantitaphong P. Risk factors, treatment modalities, and clinical outcomes of penile calciphylaxis: systematic review. World J Urol 2023; 41:2959-2966. [PMID: 37782324 DOI: 10.1007/s00345-023-04611-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE To perform a systematic review of case reports and case series to investigate risk factors, treatment modalities, and the outcome of penile calciphylaxis. METHOD We performed a systematic search of the MEDLINE and Scopus databases to identify case reports or case series of penile calciphylaxis. The patient characteristics, laboratory investigations, diagnostic modalities, treatment modalities, and outcomes were extracted. We compared clinical characteristics and treatment between patients who survived or demised and between patients with clinical improvement and those without to identify the poor prognostic risk factors. RESULTS Ninety-four articles were included from 86 case reports and 8 case series with 121 patients. Most of the patients were on hemodialysis (78.9%). The median time since starting dialysis was 48 months (24-96 months). Sodium thiosulfate was used to treat penile calciphylaxis in 23.6%. For surgical management, partial or total penectomy was performed in 45.5% of the patients. There was no association between sodium thiosulfate use, partial or total penectomy, and improvement in clinical outcomes. The mortality rate in patients with penile calciphylaxis was 47.8% and the median time to death was 3 months (0.75-9 months). The presence of extragenital involvement was significantly related to mortality (p = 0.03). CONCLUSION A calcified penile artery results in penile calciphylaxis, a rare vascular phenomenon associated with high morbidity and mortality. Management of penile calciphylaxis includes the medical management of risk factors, surgical debridement, or penectomy. Therefore, early prevention and diagnosis as well as immediate appropriate treatment are needed.
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Affiliation(s)
| | - Kullaya Takkavatakarn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Paweena Susantitaphong
- Research Unit for Metabolic Bone Disease in CKD patients, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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4
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O'Beirn E, Muheilan M, Casey R. Penile calciphylaxis-a complicated case managed with circumcision and glansectomy. J Surg Case Rep 2022; 2022:rjab590. [PMID: 35047175 PMCID: PMC8761251 DOI: 10.1093/jscr/rjab590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/06/2021] [Indexed: 11/14/2022] Open
Abstract
Penile calciphylaxis is a serious manifestation of calcifying uremic arteriolopathy, with only a small number of cases reported in the literature. It is rare, characterized by calcification within the walls of small vessels, resulting in ischaemic changes to the skin, and is mainly seen in patients with end-stage renal failure (ESRF). Management of penile calciphylaxis is difficult, with both conservative and surgical approaches advocated for. Due to their comorbidity profile, patients with penile calciphylaxis can present multiple management challenges. We present a case of penile calciphylaxis in a patient with ESRF who was initially managed conservatively, and then underwent circumcision and glansectomy due to a necrotic glans penis and non-resolving penile pain. The patient was spared a partial penectomy and went on to make a full recovery.
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Affiliation(s)
- Ellen O'Beirn
- Department of Urology, Tallaght University Hospital, Dublin D24NR0A, Ireland
| | - Muheilan Muheilan
- Department of Urology, Tallaght University Hospital, Dublin D24NR0A, Ireland
| | - Rowan Casey
- Department of Urology, Tallaght University Hospital, Dublin D24NR0A, Ireland
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5
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Kawai Y, Banshodani M, Moriishi M, Shizukawa H, Sato T, Shintaku S, Masaki T, Kawanishi H. Penile calciphylaxis in patients with end-stage kidney disease undergoing dialysis: invasive treatment and pain management. Ther Apher Dial 2022; 26:950-959. [PMID: 34984854 DOI: 10.1111/1744-9987.13789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/26/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Penile calciphylaxis is rarely reported in dialysis patients. METHODS We experienced cases of dialysis patients who had penile calciphylaxis between 2003 and 2020. RESULTS Seven patients undergoing dialysis were treated for penile necrosis (hemodialysis [HD], 5; peritoneal dialysis [PD], 1; hybrid therapy comprising PD and HD, 1). Their mean age was 62.8 years and their mean dialysis vintage 116.1 months. All had severe penile pain and were clinically diagnosed with calciphylaxis. Four received partial penectomy and three received percutaneous transluminal angioplasty (PTA) due to rapid aggravation. The number of analgesia types and the critical-care pain observation tool score significantly decreased after invasive treatment (both, P = 0.008). The 90-day and 1-year survival rates after onset were 85.7% and 57.1%, respectively. CONCLUSION In dialysis patients, penile calciphylaxis has poor prognosis; however, invasive treatments for pain management are effective. PTA may be beneficial in dialysis patients in poor condition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yusuke Kawai
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Masataka Banshodani
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Misaki Moriishi
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Hiroko Shizukawa
- Dermatology, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Tomoyasu Sato
- Radiology, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Sadanori Shintaku
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Hideki Kawanishi
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
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6
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Kouiss Y, Aynaou M, Houmaidi AE, Mhanna T, Ahmed Y, Ouraghi A, Miri A, Bennani A, Barki A. Penile necrosis by calciphylaxis leading to gangrene in a patient with chronic renal failure on dialysis: A case report. Int J Surg Case Rep 2020; 71:187-191. [PMID: 32470914 PMCID: PMC7533627 DOI: 10.1016/j.ijscr.2020.04.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/19/2022] Open
Abstract
Penile necrosis by calciphylaxis is a rare disease. The diagnosis of CUA is often difficult. The Management of this rare condition is still a matter of debate.
Introduction Penile calciphylaxis is a rare disease whose diagnosis is not easy. It is associated with chronic renal failure. It is a result of media calcification and blood vessels’ fibrosis such as penile arteries that eventually lead to gangrene formation in extremities and penis. Calcific uremic arteriolopathy is commonly associated with secondary hyperparathyroidism and high level of calcium and phosphate. Presentation of case In this paper, we report a case of penile necrosis induced by calciphylaxis associated with chronic renal failure and diabetic macroangiopathy. We performed a partial and total amputation in two stages because of the wound infection. The patient died one week after a total penectomy. Discussion The skin biopsy is the gold standard for the diagnosis despite being a risky process. In most cases, appropriate medical management is advocated. The treatment of this pathology is still controversial. Conclusion The management of this rare situation is controversial, and its diagnosis is still difficult due to the scarcity of reported cases.
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Affiliation(s)
- Youssef Kouiss
- Department of Urology, Mohamed VI University Hospital, Oujda, Morocco.
| | - Mohammed Aynaou
- Department of Urology, Mohamed VI University Hospital, Oujda, Morocco
| | - Amine El Houmaidi
- Department of Urology, Mohamed VI University Hospital, Oujda, Morocco
| | - Tarik Mhanna
- Department of Urology, Mohamed VI University Hospital, Oujda, Morocco
| | - Yacoub Ahmed
- Department of Urology, Mohamed VI University Hospital, Oujda, Morocco
| | | | - Achraf Miri
- Department of Pathology, Mohamed VI University Hospital, Oujda, Morocco
| | - Amal Bennani
- Department of Pathology, Mohamed VI University Hospital, Oujda, Morocco
| | - Ali Barki
- Department of Urology, Mohamed VI University Hospital, Oujda, Morocco
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7
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Sherif AA, Sahu KK, Li Y, Javadi H. Penile Calciphylaxis: A Rare Case of Penile Lesion. Indian J Nephrol 2020; 30:138-140. [PMID: 32269445 PMCID: PMC7132857 DOI: 10.4103/ijn.ijn_135_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/05/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Akil Adrian Sherif
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street Worcester, Massachusetts, United States
| | - Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street Worcester, Massachusetts, United States
| | - Yan Li
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street Worcester, Massachusetts, United States
| | - Houman Javadi
- Department of Internal Medicine, Saint Vincent Hospital, 123 Summer Street Worcester, Massachusetts, United States
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8
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A Rare Case of Multiorgan Calciphylaxis in a Patient with Stage 5 Chronic Kidney Disease. Case Rep Urol 2018; 2018:9603680. [PMID: 30420934 PMCID: PMC6211149 DOI: 10.1155/2018/9603680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/15/2018] [Accepted: 10/08/2018] [Indexed: 11/17/2022] Open
Abstract
Calciphylaxis or calcific uremic arteriolopathy (CUA) is a potentially life-threatening vasculopathy involving the skin and subcutaneous tissues. It is usually associated with chronic kidney disease (CKD) and rarely with acute renal failure or predialysis patients. The clinical diagnosis of calcific uremic arteriolopathy relies on high index of suspicion. CUA is commonly associated with secondary hyperparathyroidism and high serum calcium and phosphate products. Moreover, using biopsy as a diagnostic tool is controversial, due to the high risk of poor wound healing and sepsis. Radiological studies usually reveal extensive calcification of branching vessels such as penile arteries, eventually leading to gangrene formation in extremities and penis. Histopathological analysis confirms the diagnosis of calcific uremic arteriolopathy and rules out the presence of malignancy. CUA is a systematic disease that involves multiple organs, and to the best of our knowledge this is the first reported case involving the penis, bladder, and eyes.
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9
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Yang TY, Wang TY, Chen M, Sun FJ, Chiu AW, Chen YH. Penile Calciphylaxis in a Patient with End-stage Renal Disease: A Case Report and Review of the Literature. Open Med (Wars) 2018; 13:158-163. [PMID: 29756051 PMCID: PMC5941707 DOI: 10.1515/med-2018-0025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/19/2018] [Indexed: 11/15/2022] Open
Abstract
Penile calciphylaxis is a rare cause of penile gangrene that presents in patients with end-stage renal disease. The rates of comorbidity and mortality of penile calciphylaxis are extremely high. Unlike other penile gangrene, such as Fournier's gangrene, the benefit of aggressive surgical therapy is controversial. Here we present a case of penile calciphylaxis in a 43-year-old man with end-stage renal disease on hemodialysis. He received total penectomy but died due to multisystem complications 2 weeks after surgery. We review the literature on the management options and outcomes in patients with penile calciphylaxis.
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Affiliation(s)
- Ti-Yuan Yang
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Tao-Yeuan Wang
- Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Fang-Ju Sun
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Pathology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Allen W. Chiu
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Hsin Chen
- Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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10
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Miura S, Takahashi K, Akasaka T. Calciphylaxis Presenting with Various Symptoms: A Case Report. Case Rep Dermatol 2017; 9:25-29. [PMID: 28413385 PMCID: PMC5346948 DOI: 10.1159/000456000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/10/2017] [Indexed: 11/30/2022] Open
Abstract
Calciphylaxis causes ischemia in multiple organs and skin ulcers owing to progressive calcification in small and medial arteries. It has a poor prognosis and often occurs in patients with hyperparathyroidism associated with end-stage renal failure and those undergoing hemodialysis. Here, we present a case of calciphylaxis associated with a wide range of symptoms, including lower thigh skin ulcers, a rectovaginal fistula, and femoral neck fracture. The patient underwent multiple treatments. However, she eventually died of cardiac failure.
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Affiliation(s)
- Shinpei Miura
- Department of Dermatology, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kazuhiro Takahashi
- Department of Dermatology, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Toshihide Akasaka
- Department of Dermatology, School of Medicine, Iwate Medical University, Morioka, Japan
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11
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Shiraki T, Iida O, Okamoto S, Ishihara T, Fujita M, Uematsu M. Usefulness of Endovascular Therapy for Penile Gangrene Secondary to Calciphylaxis: A Case Report. Ann Vasc Surg 2015; 29:1451.e11-5. [PMID: 26122413 DOI: 10.1016/j.avsg.2015.04.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 03/31/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
We here report a case of successful endovascular therapy for penile gangrene in a patient with calciphylaxis and a long history of diabetes mellitus and end-stage renal disease on dialysis. The internal iliac artery, with 75% stenosis, was treated with balloon-expandable bare metal stent implantation, whereas the inferior gluteal artery, 75% stenosis, was treated with balloon dilatation. After endovascular therapy, the intractable penile pain immediately resolved, and penile salvage with complete wound healing was achieved 6 months after the procedure.
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Affiliation(s)
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, Hyogo, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, Hyogo, Japan
| | | | - Masashi Fujita
- Kansai Rosai Hospital Cardiovascular Center, Hyogo, Japan
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12
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Malthouse T, Lam W, Brewin J, Watkin N, Ayres B, Nitkunan T. Penile lesion in end-stage renal failure - cancer or otherwise?: Calcific uremic arteriolopathy presenting with a penile lesion. Can Urol Assoc J 2015; 9:136-7. [PMID: 26085872 DOI: 10.5489/cuaj.2331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Calcific uremic arteriolopathy or calciphylaxis is a rare condition that can present with clinical features similar to penile cancer. It is a diagnosis to consider in patients with end-stage renal failure (ESRF) presenting with a penile lesion. We describe one such case, where a patient with ESRF presented with a solid, tender penile mass and underwent surgery for presumed penile cancer. Histopathological analysis however confirmed a diagnosis of calcific uremic arteriolopathy, without evidence of malignancy. The clinical diagnosis of calcific uremic arteriolopathy relies on a high index of suspicion, and lesion biopsy is controversial due to a high risk of poor wound healing and sepsis. New treatment options are encouraging, and have been reported, albeit in small numbers. Delayed diagnosis can adversely affect both quality of life and prognosis in a condition with an extremely high mortality rate.
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Affiliation(s)
- Theo Malthouse
- Epsom & St Helier University Hospitals NHS Trust, Surrey, United Kingdom
| | - Wayne Lam
- Epsom & St Helier University Hospitals NHS Trust, Surrey, United Kingdom
| | - James Brewin
- Epsom & St Helier University Hospitals NHS Trust, Surrey, United Kingdom
| | - Nick Watkin
- Epsom & St Helier University Hospitals NHS Trust, Surrey, United Kingdom; ; St. George's Healthcare NHS Trust, London, United Kingdom
| | - Benjamin Ayres
- St. George's Healthcare NHS Trust, London, United Kingdom
| | - Tharani Nitkunan
- Epsom & St Helier University Hospitals NHS Trust, Surrey, United Kingdom
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13
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14
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Cimmino CB, Costabile RA. Biopsy Is Contraindicated in the Management of Penile Calciphylaxis. J Sex Med 2014; 11:2611-7. [DOI: 10.1111/jsm.12390] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Kim SD, Huh JS, Kim YJ. Necrosis of the penis with multiple vessel atherosclerosis. World J Mens Health 2014; 32:66-8. [PMID: 24872955 PMCID: PMC4026237 DOI: 10.5534/wjmh.2014.32.1.66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/15/2013] [Accepted: 06/18/2013] [Indexed: 11/26/2022] Open
Abstract
Penile necrosis is a very rare complication because of its rich collateral supply. Conservative management is apt to be ineffective; thus penectomy is usually performed. We present a case of penile necrosis and claudication of both legs with multiple atherosclerosis in a type II diabetes mellitus patient who was successfully treated with angioplasty, penoplasty, and additional intracavernous injections of prostaglandin E1. The treatment resulted in relief of the leg pain and healing of the penile ischemic lesions.
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Affiliation(s)
- Sung Dae Kim
- Department of Urology, Jeju National University School of Medicine, Jeju, Korea
| | - Jung Sik Huh
- Department of Urology, Jeju National University School of Medicine, Jeju, Korea
| | - Young-Joo Kim
- Department of Urology, Jeju National University School of Medicine, Jeju, Korea
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16
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Blais AS, Deschênes Rompré MP, Lacombe L. Complete Penile Necrosis in a Patient With Heparin-induced Thrombocytopenia: A Case Report. Urol Case Rep 2014; 2:21-3. [PMID: 26954936 PMCID: PMC4733004 DOI: 10.1016/j.eucr.2013.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Louis Lacombe
- Corresponding author. Tel.: +1-418-525-4444; fax: +1-418-691-5562
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17
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Arrabal-Polo MA, Pareja-Vilchez M, Lahoz-Garcia C, Gonzalez-Torres S, Valderrama-Illana P, Arrabal-Martin M. Glans necrosis produced by trauma during masturbation. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:1391-1393. [PMID: 24132777 DOI: 10.1007/s10508-013-0199-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Miguel Angel Arrabal-Polo
- Urology Department, San Cecilio University Hospital, 18, Oloriz Doctor Avenue, 18912, Granada, Spain,
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18
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Bouzouita A, Kerkeni W, Cellier L, Gobet F, Sibert L. [Penile gangrene: a rare complication of systemic calciphylaxis, to be screened]. Prog Urol 2013; 24:142-4. [PMID: 24485086 DOI: 10.1016/j.purol.2013.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 07/20/2013] [Accepted: 07/23/2013] [Indexed: 11/19/2022]
Abstract
Gangrene of the penis is a rare and serious complication of end stage renal disease, being an expression of systemic calciphylaxis. We report the case of a 58-year-old patient with chronic renal failure and diabetes, who presented with a necrosis of the gland. MRI defined the limits of necrosis. The treatment consisted in partial amputation of the penis. Histological examination found a calciphylaxis.
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Affiliation(s)
- A Bouzouita
- Service d'urologie, CHU Charles-Nicolle de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - W Kerkeni
- Service d'urologie, CHU Charles-Nicolle de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
| | - L Cellier
- Service d'anatomopathologie, CHU Charles-Nicolle de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - F Gobet
- Service d'anatomopathologie, CHU Charles-Nicolle de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - L Sibert
- Service d'urologie, CHU Charles-Nicolle de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
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19
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Yalin AS, Altiparmak MR, Trabulus S, Yalin SF, Yalin GY, Melikoglu M. Calciphylaxis: a report of six cases and review of literature. Ren Fail 2012; 35:163-9. [PMID: 23151146 DOI: 10.3109/0886022x.2012.741426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Calciphylaxis is usually a fatal condition that develops in a few chronic renal failure patients, and it is characterized by calcifications in subcutaneous arteries, infarcts in skin, and the neighboring subcutis. Calciphylaxis, once considered as a rare condition, has been reported to have an annual incidence of 1% and a prevalence of 4% in dialysis patients. We describe our clinical experience in six end-stage renal disease patients on dialysis that presented with calciphylaxis and died due to sepsis, and review the pathogenesis, epidemiology, clinical and histopathologic features, and treatment of calciphylaxis. Physicians should initially consider the possibility of calciphylaxis in case of development of skin lesions in chronic renal failure patients with impaired calcium, phosphorus, and parathyroid hormone levels. The most important cause of mortality in this condition is infection. Therefore, differential diagnosis of these lesions from systemic vasculitis in their early stages and withdrawal of immunosuppressive therapy that increases the tendency to infections are essential.
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Affiliation(s)
- Ayse Serap Yalin
- Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Three Cases of Penile Calciphylaxis: Diagnosis, Treatment Strategies, and the Role of Sodium Thiosulfate. Urology 2012; 80:5-8. [DOI: 10.1016/j.urology.2012.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 03/22/2012] [Accepted: 04/07/2012] [Indexed: 11/15/2022]
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Abstract
Calcific uremic arteriolopathy (CUA), or calciphylaxis, is an uncommon and underrecognized disease that often occurs in the setting of chronic kidney disease or end-stage renal disease. It is characterized by small-vessel calcification, although many times it is associated with normal serum levels of calcium, phosphorus, and parathyroid hormone. The lesions appear as necrotic eschars, ulcerations, indurated nodules, and dry gangrene and are usually very painful. Diagnosis is based on clinical judgment and recognition of characteristic skin lesions. Biopsy can be performed but may be complicated by poor wound healing. Treatment of CUA involves rigorous wound care, strict control of mineral metabolism with avoidance of calcium and vitamin D analogs, and pain control. Other treatment options include sodium thiosulfate, hyperbaric oxygen therapy, daily hemodialysis using low-calcium dialysate, and bisphosphonates. Even with treatment, CUA is associated with significant morbidity and mortality. The patient in the case reported here had characteristic skin lesions and several risk factors for CUA, but diagnosis was delayed.
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Lee JL, Naguwa SM, Cheema G, Gershwin ME. Recognizing calcific uremic arteriolopathy in autoimmune disease: an emerging mimicker of vasculitis. Autoimmun Rev 2008; 7:638-43. [PMID: 18774119 DOI: 10.1016/j.autrev.2008.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Accepted: 02/16/2008] [Indexed: 12/19/2022]
Abstract
Calcinosis has long been associated with autoimmune disease and has a distinctive profile in scleroderma, dermatomyositis, systemic lupus erythematosus, and overlap syndromes. However, there have also been a number of case studies of calcific uremic arteriolopathy, or calciphylaxis, described within vessels, including patients with chronic renal insufficiency and several forms of vasculitis. Interestingly, the calciphylaxis associated with vasculitis appears to be unique, although relatively uncommon and is likely secondary to a disruption in the calcium-phosphate-parathyroid hormone axis. However, there appears to be an additional trigger, given that calciphylaxis is seen both in the absence of chronic kidney disease, and in the absence of a deranged calcium-phosphate-parathyroid hormone axis. These additional triggers include a high female predominance, obesity, diabetes and, possibly, warfarin use. In this review, we describe the clinical features of calciphylaxis, particularly in the context of autoimmune disease.
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Affiliation(s)
- Jennifer L Lee
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA 95616, United States
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