Persistent purulent drainage from the glans penis: atypical presentation of pyoderma gangrenosum.

A 28-year-old man with ulcerative colitis presented with a 2-month history of persistent purulent drainage from the glans penis. Symptoms began with the appearance of a small pustule on the glans followed by spontaneous drainage that was associated with tenderness and induration. Computerized tomography and magnetic resonance imaging conducted elsewhere were unremarkable except for colonic wall thickening consistent with a prior diagnosis of ulcerative colitis. Gram and acid-fast stains, and fungal, and aerobic and anaerobic bacterial cultures were negative. The patient recalled a history of intermittent fevers, pain, swelling and purulent drainage from the glans despite treatment with broadspectrum intravenous and oral antibiotics. In addition to medical management, he had previously undergone 3 separate incision and drainage procedures for a suspected penile abscess. Physical examination revealed purulent drainage from incision sites made in the glans 2 weeks previously (fig. 1). Erythema, induration and multiple pustules were also present on the glans. Gross examination of the penile shaft, scrotal skin and rectum was unremarkable. No other cutaneous lesions were noted. The patient had a fever of 102F, and complete blood count demonstrated mild leukocytosis (white blood count 14,300, normal 4,500 to 11,000). Other laboratory data were unremarkable, and repeat bacterial and fungal cultures remained negative. Biopsy of the ulcerative glans lesion showed acanthosis of the epidermis with extensive fibrinoid necrosis and neutrophilic infiltration (fig. 2). There was no evidence of bacteria or fungus using additional stains. These clinical and histological findings were consistent with a diagnosis of pyoderma gangrenosum. Within 24 hours following initiation of oral prednisone the patient was afebrile and the glans drainage had decreased significantly. The patient was discharged from the hospital on a regimen of oral prednisone, and at 1-week followup the wounds had healed dramatically, with resolution of the purulent drainage. Accepted for publication December 6, 2002. * Financial interest and/or other relationship with Transurgical.