Aseptic Cavernosal Abscess: An Unrecognized Feature of Neutrophilic Dermatosis

Abstract

A 50-year-old man developed a sterile cavernosal abscess followed by prominent features of necrotizing neutrophilic dermatosis. We conducted a literature review, which revealed that aseptic abscesses in the corpus cavernosum occur in association with neutrophilic dermatosis. Patients with this condition frequently receive unnecessary antibiotic treatment and surgical interventions. Although this condition responds to systemic corticosteroids, the functional prognosis of the penis is poor. Abscess formation may be the initial presentation of neutrophilic dermatoses, and underlying conditions may even be absent. Clinicians need to be aware of this condition to distinguish it from bacterial infection and initiate early disease-specific treatments.

Keywords: aseptic abscess; corpus cavernosum; corticosteroids; neutrophilic dermatosis; pyoderma gangrenosum.

Figure 1.

Computed tomography (CT) and magnetic resonance imaging (MRI) findings of the patient. Vaguely demarcated low-density area in the right corpus cavernosum visible on contrast-enhanced CT at admission (Panel A). T2-weighted MRI performed on day 2 showing an abscess measuring 6 cm (Panel B). A small pulmonary nodule with central cavitation appearing in the left upper lobe on day 13 (Panel C) completely disappeared on repeat CT performed on day 33.

Figure 2.

Cutaneous findings of the patient. Cutaneous lesions on the left forearm on day 14 (Panel A). Three painful indurations are visible along an erythematous vein (arrows). Purulent necrotic ulcers can be noted on the dorsal penis and scrotum, where surgical invasion occurred (Panel B). The penis progressively formed dry gangrene, while the surrounding ulcers did not expand further (Panel C).

Figure 3.

Pathological findings of the penis. Biopsy specimen of the necrotic ulcer showing prominent neutrophilic infiltrate in the dermis and subcutaneous tissue [Hematoxylin and Eosin staining (50×)]. The square displays an increased magnification (100×).

Figure 4.

The clinical course of the patient. The observed findings of the cavernosal abscess, necrotic ulcers, and penile gangrene are shown in visual scales with curves reproduced from the patient’s medical record. The peaks of the curves indicate the worst clinical observations. The patient was administered oral prednisolone instead of methylprednisolone on days 17 and 18. mPSL: methylprednisolone, WBC: white blood cell