A Unique Case of Penile Necrotizing Fasciitis Secondary to Spontaneous Corpus Cavernosal Abscess

Corpus cavernosal abscess and necrotizing fasciitis occur rarely, and precipitating factors can usually be elicited with careful history and examination. Whilst both conditions share common risk factors such as diabetes mellitus, this is the first reported case of penile necrotizing fasciitis secondary to spontaneous corpus cavernosal abscess in an otherwise healthy patient. A 32-year-old man presented with 4-day history of swollen, painful penis, with ultrasound confirming corpus cavernosal abscess. Biopsies were taken and the cavity aspirated, but, despite intravenous antibiotics, he developed penile necrotizing fasciitis necessitating open cavernostomy and debridement. The overlying skin defect healed by secondary intention, but the patient experienced persistent postoperative erectile dysfunction, so he was referred for penile prosthesis insertion. 1. Introduction Spontaneous abscesses of the corpus cavernosum are rare, with few previously described idiopathic cases. ？The most frequently identified risk factors include relative immunosuppression (e.g., diabetes mellitus) or preceding local or distant infection [1–3]. Penile instrumentation, injection, and trauma have also been described as precipitating factors [4–7]. In this paper we report a case of spontaneous primary corpus cavernosal abscess with subsequent development of penile necrotizing fasciitis. Whilst both conditions share common risk factors [8], to the best of our knowledge this clinical course has not been described in an otherwise healthy patient. 2. Case Presentation A thirty-two-year-old man presented with a four-day history of a swollen and painful penis and left testicle with associated rigors, lower back pain, nausea, and vomiting. There was no history of lower urinary tract symptoms, haematuria, penile discharge, trauma, or unprotected sexual intercourse. His past medical history included mild asthma and hay fever, but he took no regular medications. Abdominal examination was unremarkable, and his genitalia were very swollen and tender on palpation. The patient was pyrexial (38.4°C) and tachycardic (rate 120 b.p.m.) on admission, but blood pressure was stable. Urine dipstick was positive for blood and ketones only. White cell count was 16.24 × 109/L, C-reactive protein was 158？mg/L but urea and electrolytes, liver function tests, glucose and haemoglobin were all within their normal range. Empirical intravenous amoxicillin and gentamycin treatment was commenced as per local protocol after discussion with microbiology. Ultrasound showed a 3.5 × 2.5 × 2？cm irregular mass lesion