A case of Wegener's granulomatosis with necrosis of the penis

A 31-year-old male had a sudden onset of painful swelling in the penile root region. He then developed necrosis of the penis and further a progressive, chemotherapy-resistant ulcer which involved the perineal region also. Histologically there was evidence of neither malignancy nor specific inflammation, but there were granulomatous tissues with cellular infiltration and scattered vascular necrosis. Examination of the nose suggested gangrenous rhinitis with perforation of the nasal septum. X-ray examination revealed that the nasal septum and conchae had disappeared. Chest roentgenogram also revealed increased hilar shadows in both fields of the chest. Routine laboratory examinations showed slight albuminuria and a normal BUN level. Positive findings included leucocytosis, hyper-gamma-globulinemia, accelerated ESR, positive RA and CRP tests. The patient's death was caused by bleeding from gastric ulcer and pulmonary failure.