Clinical Challenge in Urology: A Nonhealing Wound on the Glans Penis

Abstract

A 63-year-old male presented to his surgeon 6 months following circumcision for phimosis with complaints of a nonhealing wound on the glans penis. He reported persistent bleeding, pain, and progressive difficulty urinating in the months following the procedure. He was noted to have a grossly dehisced circumcision, with erythematous, beefy granulation tissue involving the entire glans (Fig. 1). Biopsy taken from the glans demonstrated pseudoepitheliomatous hyperplasia, intraepidermal microabscess formation, and focal subepidermal vesiculation overlying brisk inflammation including neutrophils, plasma cells, eosinophils, and lymphocytes (Fig. 2). Infectious workup revealed MRSA on tissue culture (treated without clinical improvement), negative HSV PCR, and negative special stains and tissue cultures for mycobacterial and fungal species. Further laboratory evaluation included rapid plasma reagin (RPR), antineutrophilic cytoplasmic autoantibody (ANCA), Hepatitis A/B/C, HIV, Lyme, antineutrophilic antibody (ANA), and tuberculosis interferon-γ release assay (IGRA)—all were unremarkable/negative. There was no clinical improvement with topical lidocaine, antibiotic ointment, testosterone, halobetasol cream, and courses of oral antibiotics and fluconazole.