Penile lymphoedema in association with asymptomatic Crohn’s disease

Abstract

Conflict of interest: none declared. A 27‐year‐old man presented with a 10‐year history of intermittent genital oedema in association with pain and inguinal lymphadenopathy without any other systemic symptoms. Physical examination showed that the patient had been circumcised. There was gross penile oedema affecting the shaft and glans penis (Fig. 1). Laboratory investigations of blood were unremarkable, including normal inflammatory markers, apart from a raised antistreptolysin titre of 400–600 U/mL (normal range 0–200). The differential diagnosis included idiopathic chronic penile lymphoedema and granulomatous lymphangitis. The patient was initially treated with oral antibiotics based on a diagnosis of possible lymphoedema associated with streptococcal infection. He was then treated with prolonged courses of clarithromycin (up to 500 mg twice daily) followed by clindamycin 150 mg twice daily, which led to some improvement. The patient was subsequently referred for a gastroenterology opinion, owing to lack of a definitive cause for his disease. A colonoscopy was performed, which showed inflammation and ulceration in the terminal ileum and caecum. Histology showed patchy chronic inflammation with ulceration and granulomas in the terminal ileum and caecum (Fig. 2). The diagnosis of ileocaecal Crohn’s disease was made.