Tuberculosis of Penile ShaftA Rare Clinical Presentation

Abstract

Tuberculosis (TB) is an opportunistic infection caused by Mycobacterium TB, and it has plagued mankind since ages, posing a major health concern in developing countries. Pulmonary TB is the most common form, but extrapulmonary TB is also not uncommon, with an incidence of 8-14%. Cutaneous manifestations of TB, known as lupus vulgaris, are extremely rare, constituting less than 1% of cases worldwide. Diagnosing a cutaneous lesion of TB poses a challenge for clinicians, as it requires both absolute and relative criteria. In the present case report, the author presents the case of a 15-year-old male from a low socio-economic background who presented with painless oedema over the penis for one and a half months. The patient had a history of dry cough and tested positive for Coronavirus Disease-2019 (COVID-19). Systemic examination was normal, and vital signs were stable. Local examination revealed oedema, redness, and phimosis over the penile shaft, along with non tender ulcerative lesions and deep cracks in the groin crease. A skin biopsy revealed lymphocytic infiltration with Langhanstype giant cells and epithelioid cell granulomas, suggesting TB of the skin overlying the penis. Laboratory investigations revealed a positive Mantoux test and an elevated Erythrocyte Sedimentation Rate (ESR) of 42. The patient was initiated on antitubercular therapy, comprising isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE). After one month of treatment, the oedema subsided, and the penile ulcers and groin skin cracks healed. Penile skin involvement in TB is rare, and the clinical appearance of such involvement may vary.