Papulonecrotic tuberculid of glans penis: A common disease at an uncommon site
A 65-year-old man presented with recurrent crops of multiple asymptomatic papulopustules over the glans penis since last 1 year. The lesions used to resolve spontaneously in a few days with scarring. He was treated with systemic antibiotics and various topical applications before referral. There was no history of trauma, drug intake, fever, cough, and constitutional symptoms. There was no personal or family history of TB. The patient denied history of unprotected sexual exposure. He denied any history of genital lesions or discharge in his wife. The patient was never vaccinated with Bacillus Calmette-Guérin (BCG).\nExamination revealed multiple, nonindurated, well-defined ulcers of size 0.5 cm × 0.5 cm over the ventral aspect of glans. Multiple irregular depressed scars were present around the ulcers []. The ulcers were nontender on touch and there was no bleeding on palpation of the ulcers. There was no clinical evidence of epididymo-orchitis. There was no significant inguinal lymphadenopathy. Mucocutaneous, appendageal and systemic examinations were normal. Patient's systemic examination was unremarkable.\nAll hematological and biochemical investigations were normal except for highly raised erythrocyte sedimentation rate (50 mm in the 1st h). Tuberculin (Mantoux) test was strongly positive (30 mm × 20 mm). Ziehl-Neelsen stain of the pus did not demonstrate any acid fast bacilli (AFB). X-ray chest did not reveal any radiological evidence of pulmonary TB. Urine sediment examinations for AFB and urine culture were noncontributory. Radiological and ultrasound evaluation of the genitourinary system was normal. Human immunodeficiency virus (HIV) antibodies test and Venereal Disease Research Laboratory test (VDRL) test were nonreactive. Systemic evaluation for any focus of TB was unremarkable.\nBiopsy from the edge of the ulcer (glans penis) showed dermoepidermal necrosis surrounded by a poorly formed granulomatous infiltrate composed of lymphocytes and macrophages []. Ziehl-Neelsen stain for AFB was negative. Tissue cultures for bacteria and fungus were negative. We were unable to perform tissue polymerase chain reaction (PCR) due to financial constraints.\nHe was treated with antituberculous treatment (ATT) for a period of 6 months. Four weeks after the initiation of therapy, the existing lesions over the glans had healed []. Further follow-up showed improvement in the condition and no recurrence.