Penile Calciphylaxis

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A 43-year-old obese man with type 2 diabetes, chronic kidney disease, and high blood pressure, resident of Southern Australia presents with penile gangrene

A diagnosis of calciphylaxis of the penis was made the patient, unfortunately, developed gangrene secondary to that which forced his treating surgeons to amputate his gangrenous penis.

Calciphylaxis is characterized by the accumulation of calcium in the small blood vessels of the tissues and fat.  Calcium accumulation in the blood vessels can lead to clotting of the blood, subsequently compromising the blood supply to the particular organs, in this case, penis, leading to skin ulcers, infections, gangrene, and necrosis.

Calciphylaxis affecting the penis is called penile calciphylaxis or calcific uremic arteriolopathy (CUA) of the penile arteries. Penile calciphylaxis is a rare disease that is characterized by calcification of the media and intimal hypertrophy along with small vessel thrombosis. Diabetes and chronic kidney disease, as seen in this patient, increase the risk of calciphylaxis.

The severity of the condition drives the treatment approach. If medical management is opted for, then normalizing the levels of serum calcium and phosphate is dispensable. Analgesics, hyperbaric oxygen, sodium thiosulfate (STS), antibiotics, and wound care are a part of conservative management.

If severe enough to warrant surgical management, then wound debridement or penectomy may be necessary. It is imperative to choose the correct management approach according to the patient’s condition as its mortality rate is high.

Penile calciphylaxis has an average mortality rate of 64 percent, with time from diagnosis of death to be around 2.5 months in most of the affected patients.

The patient in the discussion here underwent partial penectomy, where the gangrenous tip of his penis was removed, leaving a penile stump behind. Later a reconstructive surgery of his penis was performed.

References:

Campbell RA, Alzweri LM, Sopko NA, Macura KJ, Burnett AL. Penile Calciphylaxis: The Use of Radiological Investigations in the Management of a Rare and Challenging Condition. Urol Case Rep. 2017;13:113-116. Published 2017 May 11. DOI:10.1016/j.eucr.2017.03.008

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. Published 2018 May 9. DOI:10.1515/med-2018-0025

Sandhu G, Gini MB, Ranade A, Djebali D, Smith S. Penile calciphylaxis: a life-threatening condition successfully treated with sodium thiosulfate. Am J Ther. 2012;19(1):e66-e68. DOI:10.1097/MJT.0b013e3181e3b0f2

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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