Locoregional Surgery for Infected Penile Squamous Cell Carcinoma With Bulky Nodal Disease: A Case Report

For chemotherapy-fit patients with clinical N3 (cN3) penile squamous cell carcinoma (SCC), contemporary guidelines favor neoadjuvant cisplatin- and taxane-based chemotherapy followed by consolidative surgery when feasible. Severe tumor-associated infection and necrosis may, however, temporarily alter this sequence. A 53-year-old man with poorly differentiated penile SCC had previously undergone glansectomy and left inguinal lymphadenectomy, followed by one cycle of paclitaxel, ifosfamide, and cisplatin (TIP). After relocating to São Paulo, he was lost to oncologic follow-up and did not complete systemic treatment. On hospital day (HD) 1 of the current admission, he presented with extensive ulcerated and necrotic locoregional disease, purulent drainage, and sepsis. Initial management included meropenem, clinical stabilization, cross-sectional restaging, and multidisciplinary assessment while resumption of systemic therapy was considered. Imaging demonstrated bulky bilateral inguinal and pelvic nodal disease without radiologically evident distant metastases, consistent with cN3M0 disease. Persistent purulent drainage despite medical treatment led to operative management on HD26. The procedure combined resection of contiguous infected and malignant locoregional disease with an oncologic pelvic nodal dissection during the same anesthetic. The postoperative course was complicated by wound dehiscence and arterial hemorrhage on postoperative day (POD) 16, requiring left external iliac artery angioplasty using polytetrafluoroethylene (PTFE). This was followed by Pseudomonas aeruginosa bacteremia with a highly restricted susceptibility profile, recurrent systemic inflammatory signs and wound drainage, PTFE removal with arterial ligation, progressive lower-limb ischemia, and death on POD32. This case illustrates an uncommon scenario in which persistent tumor-associated infection altered the usual sequence of multimodal treatment and prompted combined infectious and oncologic locoregional surgery, followed by severe vascular and infectious morbidity.