title: Penile necrosis by calciphylaxis in a diabetic patient with chronic renal failure.
abstract: The patient was a 41-year-old man who had suffered from diabetes for 24 years and had been on insulin therapy for 17 years. The patient had commenced hemodialysis in 1999. Some of his toes on both feet had been amputated in 2000 due to diabetic gangrene. The patient was admitted to our hospital in early March 2005 complaining of a painful ulcer on the tip of the penis. At the time of admission, multiple ulcers and necrosis were observed on the prepuce and penis, as well as an ulcer on the left foot and gangrene of the left great toe. Imaging studies demonstrated severe arteriosclerosis with calcification of both large and small arteries. After penile amputation was performed because of severe pain, the wound became ulcerated, and a rectal ulcer as well as skin ulcers also developed in the bilateral inguinal regions. The penile necrosis, skin ulcers, and rectal ulcer were thought to have been caused by calciphylaxis. Calciphylaxis is a disorder in which necrosis occurs at sites of arterial obstruction and calcification, and the prognosis is poor. Seventeen patients with penile necrosis due to calciphyalxis, including our patient, have been reported in Japan. They all had a long history of diabetes, and 15 of the 17 patients were on dialysis.
authors.affiliation: Department of Internal Medicine, Division of Metabolism and Endocrinology, St. Marianna University School of Medicine, Kawasaki. a2oota@marianna-u.ac.jp
authors.forename: Akio
authors.initials: A
authors.lastname: Ohta
authors.forename: Shintaro
authors.initials: S
authors.lastname: Ohomori
authors.forename: Tomoko
authors.initials: T
authors.lastname: Mizukami
authors.forename: Ryusei
authors.initials: R
authors.lastname: Obi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D002115:Calciphylaxis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D007150:Immunohistochemistry; D007564:Japan; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D009336:Necrosis / Q000473:pathology; D010409:Penile Diseases / Q000150:complications* / Q000473:pathology* / Q000628:therapy; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D012883:Skin Ulcer / Q000150:complications / Q000473:pathology* / Q000628:therapy; D014057:Tomography, X-Ray Computed