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.