A 62-year-old patient without known drug allergies, with a history of depressive syndrome in medical treatment, diagnosed with bladder cancer (TUC) + Radiotherapy (pT2G2) 11 years ago, who underwent conservative chemotherapy with Replase
Urothelial stricture: Disease free patient for 11 years, until he was diagnosed of a distal left ureteral tumor by intravenous urography, so a left nephroureterectomy was performed (pathological anatomy3).
Three months later, a TUR was performed due to recurrence of bladder tumor (pT2G3) with involvement of the trigone. Subsequently, adjuvant chemotherapy treatment with retroperitoneal Carboplatin and Gemcitabine was started.
Three months after TURP, the patient was admitted from the emergency department with poor general health, decreased level of consciousness and fever.
Upon arrival to the emergency department, the patient had a 39o C fever with a free chill and obtundation.
The abdomen was blade and depressible, non-peritonitic.
A tumescent penis with necrotic glans and purulent suppuration was observed, with palpable bilateral inguinal lymphadenopathy.
On rectal examination, the prostate was medium and with a stony consistency.
The neurology service requested an assessment that showed a confusional state with disorientation and aphasia, without campimetry deficit or apparent motor deficits.
Blood tests showed hematologic malignancy 3, 10,000 leukocytes, 87% platelets, coagulation and normal renal function.
A CT scan of the brain ruled out the presence of acute lesions and an abdominal ultrasound did not show any abnormalities.
The screening of benzodiazepines, barbits and opioids in blood was negative.
The case was oriented as a septic picture of genitourinary origin secondary to purulent necrosis of glans and a total penectomy + perineal urethrostomy was performed.
During the postoperative period, an abdominal-pelvic CT was performed, which reported the presence of three nonspecific hepatic hypodense puntiform images.
Bilateral adrenal masses suggestive of adenomas, adenopathies larger than 1 cm peri-aortic vessels, mass in front of left iliac psoas of 3 cm, compatible with local recurrence.
Urinary tract with diffusely thickened walls, predominantly in the anterior face and with perivesical fat infiltration.
Blood and urine cultures were negative (probably because the patient had been taking amoxicillin-clavulanic acid during the previous week).
Interrogating the patient explained that he had had a non-painful priapism for a month and that a week ago he had presented a necrotic male on the glans penis because he had started the antibiotic treatment of the family.
The patient had a good clinical evolution, so he was discharged.
Pathological anatomy showed an invasion of the entire penis due to recessive cysts and surrounding fibrous tissue due to high-grade urothelial carcinoma.
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The patient was discharged by clear and spontaneous urination through the perineal urethrostomy.
She is currently undergoing chemotherapy treatment that she had started (GEM-BPC), with stabilization of her condition.
