Necrotizing vasculitis of the penis in systemic lupus erythematosus.

Abstract

Systemic lupus erythematosus is an idiopathic autoimmune disease with clinical manifestations comprising a wide spectrum of signs and symptoms involving all major organ systems. Cutaneous lesions are among the most common signs of the disease, which include malar dermatitis, discoid rashes, alopecia, painless oral ulcers, photosensitive skin eruptions and vasculitis of the skin.' Cutaneous lupus vasculitis may present as skin erythema, petechiae, epidermal necrosis, purpuric lesions and ulcerations.2 To our knowledge we report the first case of necrotizing vasculitis of the penile skin as a manifestation of the acute exacerbation of systemic lupus erythematosus. Presentation, diagnosis and management are discussed. CASE REPORT A 33-year-old man presented with acute onset of swelling and tenderness of the penis, which was associated with severe exacerbation of systemic lupus erythematosus complicated by cardiogenic shock, acute renal failure and coagulopathy. Systemic lupus erythematosus had been first diagnosed 15 years ago. Manifestations of the disease at that time consisted of oral ulcers, polyarthritis, focal proliferative glomerulonephritis, thrombocytopenia, anti-cardiolipin and antinuclear antibodies. The patient had been in stable condition and had not required any medication for the last 10 years. Physical examination revealed a white man with splinter hemorrhages and punched-out ulcers on the hands as well as petechiae and purpuric lesions on the right foot. Punched-out ulcers were also noted on the tip of the tongue. The penis was tender with marked swelling and erythema. There was a 1.5 cm.' purpuric skin lesion surrounded by petechiae over the ventral surface of the distal penile shaft. This erythematous area progressed in 2 weeks to involve 3 cm.' with a 0.5 cm.2 area of central hemorrhagic skin necrosis. The patient was initially treated with broad-spectrum antibiotics, intravenous steroids and supportive measures. During the next 10 days the penile lesion markedly increased to 7 x 3 cm. with frank skin necrosis of 3 of the distal penis