Unexplained Giant Genital Enlargement: Is It Due to Inverse Psoriasis?

A healthy 54-year-old man previously presented to vascular surgeons with a 4-year history of swelling of the penis and scrotum was scheduled for ultrasound evaluation in the angiology office in our department. At presentation, there was a giant enlargement of the penis and scrotum, without swelling of the legs. Ultrasound evaluation was negative for vascular abnormalities. A diagnosis of chronic lymphatic disease was suspected; thus, a lymphoscintigraphy was performed. This test was normal showing, a good visualization of major lymphatics. The patients had a history of psoriasis with a documented previous event of flexural psoriasis involving his genitals with secondary infection 4 years before. Since that infection, his genitals progressively increased in size, and despite medical treatment and different surgical evaluations, the patient's symptoms have not resolved, with marked disability associated with walking and sexual activity.