Primary cutaneous TB of the penis (tumor like lupus vulgaris)

Background- Cutaneous tuberculosis constitutes a minor portion of extra pulmonary tuberculosis (2%) mainly caused by mycobacterium tuberculosis, from cutaneous tuberculosis the external genitalia is very rarely involved (0.2-2%), and the penis is extremely rare site of involvement and few cases described in the literature Clinical case-A 64 years old male patient presented with initially few and small lesions on the shaft of the penis and progressively increased in number and in size over 04 years, the lesions have associated foul smelling discharge, but no ulceration or discharge per the urethral meatus and repeatedly treated at local health center for STI with unspecified injections and po medication but no improvement Pertinent physical finding- grossly deformed penis (?saxophone penis) multiple skin colored to hyper pigmented firm nodules with variable size with associated minimal foul smelling purulent discharge over the shaft of the penis and extension to the glans and discrete nodule with scarred edges over the perineum, No lymphadenopathy. Culture result pending Conclusion – with the above findings TB of the penis was entertained and patient was started on first line Anti TB and all family members and close contact were screened and all had no evidence of TB, appointed to plastic surgery for reconstructive surgery. oul smelling purulent discharge over the shaft of the penis and extension to the glans and discrete nodule with scarred edges over the perineum, No lymphadenopathy. Lab finding leukocytosis with raised ESR,discharge analysis is positive for AFB,FNAC-granuloma with caseaous necrosis ,no focus of active TB on other organs(Chest XRAY and abdominal u/s normal) Culture result pending Conclusion – with the above findings TB of the penis was entertained and patient was started on first line Anti TB and all family members and close contact were screened and all had no evidence of TB, appointed to plastic surgery for reconstructive surgery.

Author(s): Dr Betelhom

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