An 83-year-old male, with type II DM, who underwent surgery on two occasions for a urothelial carcinoma of the bladder by TUR, after which he received adjuvant treatment with weekly intravesical mitomycin, followed by maintenance bladder treatment with 40 mg.
After the fifth instillation of the maintenance treatment, the patient presented urethral dilation, associated with an intense genital cutaneous reaction as well as systemic drug eruption, being diagnosed with a possible allergic reaction to mitomycin.
The patient was treated symptomatically with corticosteroids and referred to the dermatology department of the hospital where the evolution was monitored.
Two months later, after a period in which the eruption had shown a favorable progress, although without completely resolved, the patient came to the emergency department for worsening of the lesions, being diagnosed with an overinfection.
Systemic antibiotic treatment was initiated empirically (ciprofloxacin 500mg every 12 hours), associated with the administration of topical corticosteroids.
Despite treatment, three days later the patient returned to the emergency room for an increase in erythema with redness in the genital area, as well as an increase in the perimeter of both lower limbs.
On physical examination an extensive ulcer was detected in the posterior aspect of the penis and in the anterior face of the scrotum, with elevation of local temperature as well as edges of necrotic skin in the legs.
After evaluation by the Plastic Surgery Department, it was decided to perform a surgical intervention to debrid necrotized tissue.
During admission, several abscesses were recorded, and the patient was operated on several occasions to debrid more fibrotic-fibrotic tissue, testicular tissue, and recurrent lesions of the gallbladder, which were treated conservatively.
The microbiological culture of the wound revealed that the superinfection was due to Enterococcus tecali, so she was treated with oral midazolam at a dose of 1,000 mg every 6 hours for 24 days.
After the resolution of the superinfection, a reconstructive plastic surgery was programmed, using healthy skin of the scrotum to cover the areas without penis and testicles; likewise, a urethroplasty was performed.
