IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 3754 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   [PDF Not available] *
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    Introduction
    Case 1
    Case 2
    Case 3
    Discussion
    References

 Article Access Statistics
    Viewed6451    
    Printed131    
    Emailed8    
    PDF Downloaded0    
    Comments [Add]    
    Cited by others 3    

Recommend this journal

 
CASE REPORT
Year : 2002  |  Volume : 68  |  Issue : 3  |  Page : 164-165

Genital tuberculosis


Department of Dermatology and Venereology, Malabar Institute of Medical Sciences, Calicut - 673 016, India

Correspondence Address:
Department of Dermatology and Venereology, Malabar Institute of Medical Sciences, Calicut - 673 016, India

   Abstract 

Three cases of tuberculosis of the penis are reported. The first two cases were papulonecrotic tuberculids over the glans penis and the third case was tuberculous ulcer of the penis. In the first 2 cases, no focus of tuberculosis infection could be detected. The third case had pulmonary tuberculosis. All our patients responded to treatment with antituberculosis drugs.

How to cite this article:
Anoop U C, Pavithran K. Genital tuberculosis. Indian J Dermatol Venereol Leprol 2002;68:164-5


How to cite this URL:
Anoop U C, Pavithran K. Genital tuberculosis. Indian J Dermatol Venereol Leprol [serial online] 2002 [cited 2019 Dec 6];68:164-5. Available from: http://www.ijdvl.com/text.asp?2002/68/3/164/12556



   Introduction Top

Tuberculosis of the penis is extremely rare even in developing countries where the prevalence of tuberculous infection is high. Recently, we had 3 cases of penile ulcers due to tuberculosis.

   Case 1 Top

A 35 - year -old unmarried man presented with multiple ulcers over the glans penis. For 4 months, he was having fever, weight loss and painful papules over the glans penis which ulcerated. He denied history of recent sexual exposures. The ulcers were of 0.5 - 1 cm in size, with irregular punched out edges. The floor was covered with crust and the ulcers were tender and non-indurated. The superficial inguinal lymph nodes on both sides were enlarged, firm and non - tender. Dark ground examination for Treponema pallidum, gram stain for H. ducreyi and tissue smear for Donovan bodies were negative. Blood VDRL was non reactive and screening test for HIV was negative. Mantoux test was positive 15 mm. Chest x -ray and ultrasound abdomen were normal. No focus of tuberculosis could be found out. Biopsy from the ulcer showed tuberculoid granuloma and features of vasculitis. A diagnosis of papulonecrotic tuberculid over the glans penis was made. He was treated with INH 300 mg daily, rifampicin 600mg daily, ethambutol 800mg daily and pyrazinamide 1500mg daily for 2 months, followed by INH 300mg daily and rifampicin 600mg daily for 4 months as per the WHO recommendation. The ulcers healed with treatment leaving thin depressed circular scars.

   Case 2 Top

A 60-year-old unmarried man who had no history of sexual exposures presented with multiple papules and ulcers over the glans penis of 8 months duration. The ulcers were 2-5mm in size, had punched out edges, and were tender and non-indurated. They were covered with brownish crust, removal of which revealed underlying pale granulation tissue. The inguinal lymph nodes on both sides were enlarged, non tender. Dark ground examination, gram stain and tissue smear showed no organism. Blood VDRL test and ELISA test for HIV were negative. Mantoux test was positive 15mm. Chest X-ray and ultrasound abdomen were normal. No focus of tuberculous infection could be detected. Histopathology showed tuberculoid granuloma and features of vasculitis [Figure - 1]. A diagnosis of papulonecrotic tuberculid of glans penis was made. The ulcers healed on treatment with antituberculosis drugs.

   Case 3 Top

A 55- year-old man presented with an ulcer over the glans penis of 5 months duration. It was 1.5x1 cm in size, indurated, nontender, was covered with red granulation tissue and had undermined edges [Figure - 2]. The inguina l lymph nodes were enlarged on both sides and were nontender. The dark ground microscopy for Treponema pallidum and smears for H. ducreyi and Donovan bodies were negative. Blood VDRL and ELISA test for HIV were negative. Chest X-ray showed cavitary lesions right apex suggestive of tuberculosis. Histology from the ulcer showed tuberculoid granuloma. A diagnosis of tuberculous ulcer over the penis was made and he was treated with antituberculosis drugs. The ulcer healed completely on treatment.

   Discussion Top

Although any organ or system can be affected by tuberculosis, penis is an uncommon site for its involvement. Tuberculosis affecting the penis can be tuberculous chancre, papulonecrotic tuberculid, tuberculosis cutis orificialis or tuberculous gumma. Tuberculous chancre has been reported following ritual circumcision and sexual contact.[1] The possibility of tuberculous chancre is very unlikely in our case since there was no associated suppurative lymhadenopathy. Several cases of papulonecrotic tuberculids over the glans penis have been reported previously.[2],[3],[5],[6] The first six cases were reported from Japan.[5] Papulonecrotic tuberculid is considered to be due to a hypersensitivity reaction of fragments of tubercle bacilli. It occurs in patients with a moderate or high degree of immunity to tubercle bacilli. It occurs in patients with a moderate or high degree of immunity to tubercle bacilli. The focus of tuberculosis infection is found in 30-40% of cases. The condition promptly responds to antituberculosis drugs but relapses have been reported.[4] When lesions are limited to glans penis, diagnosis can be difficult. All our cases were thoroughly investigated to rule out sexually transmitted diseases such as syphilis, chancroid and Donovanosis. A diagnosis of tuberculosis was made by clinical, laboratory and histological features. Unless the possibility of tuberculosis is considered, the diagnosis can be missed in these cases. All our patients responded to treatment. 

   References Top

1.Biornstad R. Tuberculous primary infection of the genitalia. Ada Derm Venereal (Stokh) 1947;27:106-114.  Back to cited text no. 1    
2.Kumar B, Sharma VK. Papulonecrotic tuberculids on glans penis. Dermatologica 1987;174:151-152.  Back to cited text no. 2    
3.Nishigori C, Tonigushi S, Hayakawa M. Penis tuberculids. Papulonecrotic tuberculids on glans penis. Dermatologica 1986;172:93-97.  Back to cited text no. 3    
4.Madwani NA. Papulonecrotic tuberculid - Relapse after treatment. Indian J Dermatol Venereal Leprol 1998;172:93-97.  Back to cited text no. 4    
5.Stevanovic DV. Papulonecrotic tuberculid on glans penis. Arch Dermatol 1958;78:760.  Back to cited text no. 5  [PUBMED]  
6.Pavithran K, Viiayadharan M, Gangadhran C. Populonecrotic tuberculid on glans penis. Indian J Dermatol Venereol Leprol 1982;48:42-44.  Back to cited text no. 6    

 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow