Infant penile tuberculosis following circumcision.

Area of Science:

• Pediatric infectious diseases
• Urogenital tuberculosis
• Mycobacterial infections

Background:

• Primary penile tuberculosis is exceptionally rare, particularly in infants.
• Urogenital tuberculosis often presents with renal or bladder involvement, not typically penile lesions.
• Recent travel or circumcision in endemic areas can be risk factors for disseminated tuberculosis.

Observation:

• A previously healthy 10-month-old infant developed a penile ulcer and bilateral inguinal lymphadenopathy.
• The infant had undergone circumcision in Pakistan four months prior to presentation.
• Clinical examination revealed significant swelling and ulceration of the penile shaft and enlarged inguinal lymph nodes.

Findings:

• Microscopy revealed acid-fast bacilli in penile ulcer exudate and lymph node tissue.
• Polymerase chain reaction (PCR) confirmed the presence of Mycobacterium tuberculosis DNA in both sample types.
• Culture of penile and lymph node specimens yielded Mycobacterium tuberculosis, confirming the diagnosis.

Implications:

• This case underscores the importance of considering tuberculosis in infants presenting with unusual genital lesions, especially with a relevant travel history.
• Early diagnosis and treatment are crucial to prevent complications and dissemination of the disease.
• Penile tuberculosis, though rare, should be included in the differential diagnosis of penile ulcers in pediatric populations.