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+Male patient, aged 64 years, with a history of type 2 diabetes mellitus for 20 years, poorly treated, systemic arterial hypertension diagnosed 6 months previously without treatment, heart failure diagnosed 6 months previously and diagnosis of chronic renal failure, also made 6 months previously, treated with peritoneal dialysis.
+He presented with symptoms of 2 weeks' evolution, following hospitalisation for metabolic decompensation, where a transurethral catheter was placed for 2 weeks; he reported abdominal pain in the hypogastrium, of moderate intensity and oppressive type, radiating to the glans penis, and the use of self-prescribed topical treatments without improvement. The pain intensified to the point of being incapacitating 3 days prior to admission, so he came to our department. She denied fever or other accompanying symptoms.
+Physical examination revealed an unaltered abdomen, a penis with necrosis on the glans penis and purulent discharge through the urethral meatus, as well as areas of necrosis on the first and second ortex of both feet.
+Laboratory tests showed: haemoglobin 9.9 g/dl, leucocytes 11,100, platelets 304,000, glucose 138 mg/dl, BUN 143.8 mg/dl, creatinine 7.71 mg/dl, calcium 7.79 mmol/l, phosphorus 7.08 mmol/l, potassium 5.75 mmol/l, pH 7.17, pCO2 47 mmHg and HCO3 17.1 mmol/l.
+He underwent phalectomy, firstly partial, but in the trans-operative period it was decided to perform a total phalectomy due to lack of vascularity up to the base of the penis; in addition, a perineal meatus was performed.
+The pathology report was: distal ischaemic necrosis of the glans and foreskin associated with microthrombosis and bacterial proliferation, resection edges with dystrophic calcification of the arterial media.
+The result of secretion culture was Escherichia coli, for which he received antibiotic therapy for 7 days. He was kept in hospital for 9 days and was discharged in good general condition; he is currently under surveillance.
+