PENILE NECROSIS IN DIALYSIS PATIENTS (see also Kyrle's -Dialysis) ---------------------------------------------------------------------------- ---------- The recent discussion about problems relating to silicone in dialysis patients brings to mind a trying patient that I am currently seeing . This is a 35 Y/O male , diabetic with bilateral AK amputations and end stage renal disease on a vascular basis. He presented with a patch about 2cm on his glans that looked like a fixed drug reaction but progressed to epithelial necrosis of all the skin from the corona to the urethral meatus. The skin in these areas remained healthy in appearance. Bacterial cultures grew mixed flora without clear pathogen, viral studies were neg, fungal studies were neg. I have found reference in literature to penile necrosis in dialysis patients leading to amputation but none specifically relating to the skin of the glans as an isolated event. I have tried him on trental but he could not tolerate it although the home nurse states there has been some improvement. Any of you have similar experiences or thoughts would be appreciated. L.J. Gregg MD ------------------- I had a similar problem which was, I believe, penile necrosis due to calciphlaxis...written up in the JAAD rrelatively recently. Didn't do Si levels...Perhaps we should write both of these cases up? Elliot Puritz MD --------------------- Am currently involved with a 50 yr old BM on hemodialysis; he has severe abdominal candidiasis secondary to peritoneal dialysis. He had several skin lesions on legs and arms with eschar,and had a 1.5cm black eschar on tip of penis. Biopsy of leg lesion showed leukocytoclastic vasculitis and I feel penile lesion is same. Wonder if penile changes would be due to some dialysis-induced vascular problem. Harold Rehbein --------------------- The post that I presented re: SILICON-Related Syndrome in Dialysis Patients referred to the trace element Silicon (SI)......not Silicone (Dow Chemical). Silicon is a naturally occuring trace element. Jeff Marmelzat, M.D. -------------------------- I have a very similar patient who had been dialysis dependent and recently received a renal transplant. He had seen a few derms before he got to me and had had a sig. workup: neg HIV, neg cultures for H. simplex, neg VDRL, etc. Biopsy had shown denuded epithelium, neutrophils in the dermis, and some vessels with thrombi, though there was a comment of "vasculitis". My working diagnosis was a possible pyoderma gangrenosum. Initially he cleared completely with timovate TID (this is when he was on dialysis). He then underwent a renal transplant and the penile ulceration recurred soon after there was friction to the glans from his catheter. He has gone on to develop an eschar to part of his glans and the ulceration has spread. To make matters worse the pain is extreme. The patient is however, very noncompliant with followup visits and one wonders if there is some artifact involved in the process. We did debride the eschar and further biopsies were obtained. It is hard to occlude the area to help r/o artifact. So I too would like some help with this most unusual problem! Jason Rivers MD ---------------------- I've seen calcifilaxis present this way in HD and PD patients. You might consider getting xrays of his legs to look for calcification. Guy Webster MD -------------- My humble professional thanks to Dr. Puritz and others who proposed my patient might have calcifylaxis of his glans penis. Soft tissue films of the penis, thighs, and a finger where there was a typical lesion all showed remarkable soft tissue calcification. The radiologist was very impressed by the remarkable findings let alone having a dermatologist order films(Ha). A conversation with the nephrologists revealed that the patient has never controlled his phosphorus levels and they are going to explore ways to do this and perhaps parathyroidectomy . L.J. Gregg MD ------------- ------- 4.24.96