Penile Calciphylaxis Obscured by Phimosis in an End-Stage Renal Disease Patient: A Case Report

Abstract

Penile calciphylaxis is a rare and severe complication primarily observed in patients with end-stage renal disease (ESRD) undergoing dialysis. A 50-year-old man presented with severe penile pain and phimosis. He had a history of hypertension and diabetes mellitus for 10 years, complicated by ESRD and was awaiting a cadaveric kidney transplant. He was on cinacalcet therapy for tertiary hyperparathyroidism. The patient underwent circumcision at which discolouration and necrotic patches involving the glans penis were noted. The histological findings were consistent with calciphylaxis and suppurative inflammation. However, due to persistent severe pain and progressive gangrene, a partial penectomy was performed. This report demonstrates the importance of consideration of calciphylaxis in patients with ESRD when presenting with penile pain, even phimosis.

Keywords: end stage renal disease (esrd); hemodialysis; partial penectomy; penile calciphylaxis; phimosis.

Figure 1. Discolouration of the glans penis at the time of circumcision suggestive of calciphylaxis

Figure 2. Photomicrographs (A: Right side, B: Left side) of excision biopsy of glans penis with haematoxylin and eosin stain, showing extensive suppuration, tissue necrosis, with focal calcification

Figure 3. Subsequent calciphylaxis developing in the third finger resulting in gangrene