Clinical Snapshot
Abscess at the Base of the Penis— a Rare Differential Diagnosis
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A 56-year-old diabetic male presented with severe lower abdominal pain, dysuria, fever, and pain in the genital area. Remarkable findings included elevated infection parameters, pronounced pain upon pressure in the perineal area, which was markedly exacerbated by digital palpation, as well as difficulties urinating. Urinanalysis was unremarkable, and antibiotics had already been prescribed by the primary care physician. The initial suspected diagnosis of prostatitis was called into question due to normal prostate specific antigens (PSA). Macroscopically, fungal balanitis was identified. On the basis of magnetic resonance imaging (MRI), the diagnosis that had already been suspected on ultrasound of abscess at the base of the penis was made (Figure a). Syphilis and gonorrhea could both be excluded. Contrast-enhanced MRI yielded no evidence of fistulas. Any potentially causal use of sex toys, etc., could be convincingly ruled out on the basis of patient history. An escalation of antibiotic therapy with ciprofloxacin and gentamycin led to a significant improvement in infection parameters; however, due to persistent abscess behavior, perineal drainage was performed, leading to complete remission of the abscess (Figure b). Once prostatitis has been ruled out, an abscess at the base of the penis should always be considered in the differential diagnosis.
Dr. med. Matthias Grade DTM & H FEBG, Gastroenterologie, Allgemeine Innere Medizin und Infektiologie, Christliches Krankenhaus Quakenbrück, grade@ckq-gmbh.de
Helle von Hammerstein, Allgemeine Innere Medizin und Infektiologie, Christliches Krankenhaus Quakenbrück
Michael Christlieb, Urologie Quakenbrück
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by Christine Rye.
Cite this as: Grade M, von Hammerstein H, Christlieb M: Abscess at the base of the penis—a rare differential diagnosis.
Dtsch Arztebl Int 2022; 119: 367. DOI: 10.3238/arztebl.m2022.0023
