Penile necrosis due to calciphylaxis in peritoneal dyalisis patient: A case report

Abstract

Introduction: Calciphylaxis (or calcific uremic arteriolopathy) is a life-threatening condition that affects 1–4% of patients with endstage renal disease (ESRD). Penile necrosis is one of the complications of calciphylaxis that occur in ESRD patients undergone haemodialysis. Although rarely happen, this condition is potentially life-threatening and usually has a poor prognosis. It is associated with diabetes mellitus (DM), cholesterol embolism. The treatment varies, from surgical to conservative, and is usually depends on patient’s general condition. Case presentation: A 41-years-old male, known to have ESRD and underwent hemodialysis for 1 year in 2014, but has been switched to peritoneal dialysis ever since, presented with complaints of severe pain, purulent and progressive necrosis of glans penis within the last two months, and history of long-term DM and hypertension. Physical examination showed that the patient was alert, with blood pressure of 141/80 mmHg, pulse rate of 88 bpm, respiration rate of 20 times per minute, and temperature of 36.8ºC. A yellow purulent tissue was noticed over the glans penis, foul-smelling discharge was observed from urethra and undersurface of penile lesion. Laboratory examination showed elevated calcium level of 7.3 mg/dL. Ultrasound revealed multiple calcifications at the base of penis, hypoechoic lesion, nearly circular, irregular border, likely sac with thin wall, attached to the gland penis, and filled with exudate. Doppler confirmation showed avascular area. The patient was treated with partial penectomy, debridement, and antibiotic. Conclusion: Calciphylaxis in peritoneal dialysis patients as reported in this case was rarely found. Although the treatment is still debatable, however, we decided to impose surgical approach in this patient along with antibiotics. Despite its poor prognosis, the patient in this case showed improvement after the procedure.