A 51-year-old male presented with multiple asymptomatic nonhealing ulcers over the
glans penis for last 3 months. He was a heterosexual individual with no history of
genital ulcers in the life partner. There was no history of extramarital sexual contact.
Patient denied any history of trauma, fever, cough, constitutional features, and drug
intake. On examination, there were multiple tender, mildly indurated, punched out
ulcers with irregular margins, and yellowish white necrotic slough on the floor, varying
in size from 1 cm × 1 cm to 0.5 cm × 0.5 cm with areas of depressed varioliform and
irregular pitted scarring ([Fig. 1]). There was no inguinal lymphadenopathy.
Fig. 1 Multiple ulcers on the coronal sulcus and neck of glans with irregular margins and
granulation tissue at the floor.
The Mantoux test was strongly positive (26 mm × 21 mm; [Fig. 2]). Urine examination for acid fast bacilli was negative. Ultrasound examination
of genitourinary system, chest X-ray, contrast-enhanced computed tomography chest
was not contributory. Histopathological examination revealed epidermal thinning and
necrosis with granulomatous infiltrate composed of lymphocytes and macrophages. Ziehl
Neelsen stain for acid fast bacilli was negative. Diagnosis of papulonecrotic tuberculid
of penis was made on the basis of history, clinical examination, histopathological
examination, and laboratory investigations. Antitubercular therapy was started for
6 months (isoniazid, rifampicin, pyrazinamide, and ethambutol for 2 months followed
by isoniazid, rifampicin, and ethambutol for 4 months) and complete healing with depressed
scars occurred after 4 months of therapy ([Fig. 3]).
Fig. 2 Mantoux’s test performed on volar aspect of forearm was strongly positive (26 mm
× 21 mm).
Fig. 3 Healed ulcers with depressed scars after 6 months of antitubercular treatment.
Pulmonary tuberculosis is a common infection in our part of the world; however, tuberculosis
of penis is rarely reported. Tuberculids are cutaneous lesions believed to arise from
hypersensitivity to Mycobacterium tuberculosis. Tuberculids are characterized by positive tuberculin test, evidence of present or
past tuberculosis, absence of M. tuberculosis in the skin lesions, and response to antitubercular treatment.[1]
In our part of the world, prevalence of tuberculosis is still high, and the existence
of papulonecrotic tuberculid in penile area is possible. Tuberculosis of glans penis
must be excluded if any patient present with unhealthy, nonhealing ulcer in penis.
