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.
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