A 64-year-old male patient with a history of poorly treated type 2 diabetes mellitus for 20 years, systemic arterial hypertension diagnosed 6 months previously without treatment, heart failure diagnosed for 6 months and diagnosed with chronic peritoneal dialysis for 6 months.
The patient presented with a clinical picture of 2 weeks of evolution, after being admitted for metabolic suppression, irradiated to the glans, where a transurethral catheter was placed for 2 weeks. He reported moderate abdominal pain in the hypogastrium.
The pain intensified until disabling 3 days before admission, so he went to our service.
Fever or more accompanying symptoms
On physical examination, abdomen showed no alterations, penis with necrosis on the glans and purulent secretion through the urethral meatus, as well as areas of necrosis in the first and second feet.
Laboratory tests showed: hemoglobin 9.9 g/dl, leukocytes 11.100, platelets 304.000, glucose 138 mg/dl, BUN 143.8 mg/dl, creatinine 7.71 mg/dl, phosphorus 7.79 mmol/l
The patient underwent phalectomy, which was initially partial, but during the transoperative period it was decided total due to lack of vascularity to the base of the penis; in addition, a perineal meatus was performed.
The pathology report was: distal ischemic necrosis of the glans and foreskin associated with microthrombosis and bacterial proliferation, resection margins with dystrophic calcification of the arterial media.
The culture result of secretion was Escherichia coli, so he received antibiotic therapy for 7 days.
He remained hospitalized for 9 days and was discharged in good general condition; he is currently under surveillance.
