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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2006  |  Volume : 17  |  Issue : 2  |  Page : 213-215
Primary Tuberculosis of the Glans Penis in Male Kidney Transplant Recipients: A Report on Two Cases


Department of Urology and Kidney Transplantation, Ekbatan Hospital, Hamadan University of Medical Sciences, Hamadan, Iran

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   Abstract 

An extremely rare form of genitourinary tract tuberculosis (TB) is TB of the glans penis. Here, we report on two men with TB of the glans, both occurring secondary to their wives having genital TB. To the best of our knowledge, this is the first report of this nature from Iran. One case is a 48 year-old blind male with an asymptomatic papulo-pustular eruption over the glans and, the other is a 51 year-old male who had kidney transplantation in March 2004, and was referred to our transplantation clinic nine months later with papulonecrotic ulcer on the glans which did not respond to antibiotic therapy. Both patients responded well to anti-TB treatment. Our cases suggest that every papulonecrotic lesion on the glans must raise the suspicion of TB, and an underlying active or healed focus of TB should be thoroughly searched. Also, it is very important, particularly in endemic areas, that prior to transplanting a male patient, his female partner must be examined for TB of the genitalia.

Keywords: Glans Tuberculosis, Genitourinary tuberculosis, Penile tuberculosis, Kidney transplantation.

How to cite this article:
Amirzargar MA, Yavangi M, Amirzargar N. Primary Tuberculosis of the Glans Penis in Male Kidney Transplant Recipients: A Report on Two Cases. Saudi J Kidney Dis Transpl 2006;17:213-5

How to cite this URL:
Amirzargar MA, Yavangi M, Amirzargar N. Primary Tuberculosis of the Glans Penis in Male Kidney Transplant Recipients: A Report on Two Cases. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2019 Jul 19];17:213-5. Available from: http://www.sjkdt.org/text.asp?2006/17/2/213/35793

   Introduction Top


An extremely rare form of genitourinary tract tuberculosis (TB) is TB of the glans penis. Up to 1971, a total of 139 such cases have been reported in the literature.[1],[2],[3] The glans penis may be affected in three ways:

a) Primary, as an ulcerative lesion of glans.

b) Extended through the urethra

c) Hematogenous spread

In the past, circumcision was a risk factor when mycobacterium could enter the wounded glans from affected people. [4],[5] At present, TB of the glans in adults can occur as primary or secondary forms. Primary TB of the glans can be acquired through either intercourse with a patient suffering from genital TB, or contact with contaminated fabric. The secondary form is the subsequent complication of lung tuberculosis or other organ involvements.[5] We herewith report on two cases with TB of the glans, both occurring secondary to their wives having genital TB.


   Case Reports Top


Ten years ago, we reported on one case; a 48-year-old blind male with recurrent asympto­matic papulo-pustular lesions over the glans penis who had received different antibiotic therapies without a positive response. He was then referred to our clinic and biopsy confirmed the diagnosis of TB and he was treated with anti-TB drugs.

The other case was a 51-year-old male who underwent kidney transplantation in March 2004 and nine months later found an ulcerative lesion on the glans penis, which did not respond to antibiotics and various topical ointments [Figure - 1]. He was referred to our transplantation clinic. Physical examination and routine laboratory tests including HIV and VDRL were negative. However, the ESR was raised and a Mantoux test was positive. In order to confirm the diagnosis, a biopsy of the lesion was performed which showed features con­sistent with TB [Figure - 2]. Detailed investi­gations including chest x-ray, KUB and intravenous pyelogram were normal. Urine culture for bacteria/AFB growth was negative. Pus from a pustule showed no organisms on a Gram stain and Ziehl-Neilsen staining and culture. After complete investigation, his wife was examined for genital TB, which was positive; therefore they were put on anti-TB drugs [Table - 1] along with a reduction in the dose of the immunosuppressive drugs. Two weeks after the initial therapy, the lesion over the glans healed, although the anti-TB treatment was continued for six months. Further follow-up showed improvement without recurrence.


   Discussion Top


TB of the glans penis is a lesion with a few erythematous, non-tender and necrotic papules, pustules and granulation tissue, similar to cancer of the glans. [1] Consequently, biopsy must be done to differentiate them. [5],[6] The occurrence of TB of the glans is common in endemic areas, although, these are the first reported cases from Iran. The basic ways to diagnose the papulo-necrotic TB are: physical examination revealing typical clinical features, positive Mantoux test, raised ESR and the typical histopathological findings. [5],[6],[7],[8] To differentiate primary TB of glans from secondary, chest x-ray, IVP, urine culture and culture for mycobacterium tuberculosis, must be done. [8],[9],[10] Every papulo-necrotic lesion on the glans must raise the suspicion of TB and an underlying active or healed focus of TB should be thoroughly searched. Also, it is very important, particularly in endemic areas, that prior to transplanting a male patient, his female partner must be examined for TB of the genitalia.

 
   References Top

1.Sekhon GS, Lal MM, Dhall JE. Tuberculosis of penis. J Indian Med Assoc 1971;56:316-8.  Back to cited text no. 1    
2.Lewis EL. Tuberculosis of the penis. A report of 5 new cases and complete review of literature. J Urol 1946;56:737.  Back to cited text no. 2    
3.Narayana AS, Kelly DG, Duff FA. Tuberculosis of the penis. Br J Urol 1976; 48(4):274.  Back to cited text no. 3    
4.Venkataramaiah NR, Van Raalte JA, Dutta SN. Tuberculous ulcer of the penis postgrad. Med J 1982;58:59.  Back to cited text no. 4    
5.James G, Gow MD. Campbell's urology. SAUNDERS co publishers Philadelphia 2002; Volume 1, page 750-751.  Back to cited text no. 5    
6.Basavaraj MK. Tuberculous epididymo­orchitis and papulonecrotic tuberculids of the glans penis. Indian J Dermatol Venereol Leprol 2003.  Back to cited text no. 6    
7.Fox W. Short course chemotherapy for tuberculosis. In fleneley DC (Ed): Recent advances in respiratory Medicine. 2nd ed. Edinburgh, Churchill Livingstone, 1980;83.  Back to cited text no. 7    
8.Guy M, Eisenkraft S, Elivaz A. Primary tuberculosis of the glans penis. Harefuah 1993;125(9)260-1,328.  Back to cited text no. 8    
9.Nakamura S, Aoki M, Nakayama K, Kanamori S, Onda S. Penis Tuberculide (papulonecrotic tuberculide of the glans penis): treatment with a combination of rifampin and extract from tubercle bacilli (T.B. vaccine). J Dermatol 1989;16(2):150-3.  Back to cited text no. 9    
10.Sah SP, AsokRaj G, Joshi A. Primary tuberculosis of the glans penis. Australas J Dermatol 1999;40(2):106-7.  Back to cited text no. 10    

Top
Correspondence Address:
Mohammad Ali Amirzargar
Department of Urology and Kidney Transplantation, Ekbatan Hospital, Hamadan University of Medical Sciences, Hamadan
Iran
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PMID: 16903630

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