Publication:

Penile calciphylaxis: a case report and literature review

Calciphylaxis is a rare and severe vascular disorder characterized by calcification of small vessels, leading to tissue ischemia and necrosis. It predominantly affects patients with end-stage renal disease (ESRD) and is associated with high mortality. This case report describes a 54-year-old male with ESRD on haemodialysis, diabetes mellitus, hypertension, and secondary hyperparathyroidism, who presented with intense penile pain and whitish discoloration of the glans. Despite initial supportive measures, the patient progressed to wet necrosis of the penis and prepuce, accompanied by acute testicular pain and signs of incipient necrotizing fasciitis. Empirical antibiotic therapy and analgesia were initiated, but the condition worsened, necessitating total penectomy with cystostomy due to extensive necrosis. Postoperative complications included surgical site infection, gastric ulcers, and acral necrosis, culminating in refractory septic shock and multiorgan failure, leading to death. In conjunction with this case, we review the existing literature to contextualize its findings, summarize diagnostic and therapeutic challenges, and highlight gaps in evidence. This case underscores the aggressive nature of penile calciphylaxis, its diagnostic dilemmas, and the limited therapeutic options available. Early recognition and multidisciplinary management are crucial, though prognosis remains poor.