Spontaneous Idiopathic Non-venereal Cavernosal Abscess: A Rare Case Report and Review of Literature

Penile abscesses are uncommon in urology and usually arise from trauma, intracavernous injections, systemic infections, and sexually transmitted infections (STIs). However, spontaneous cases with no definitive causes are sporadic. Here, we describe an unusual presentation in a 55-year-old man with no history of trauma, diabetes, immunosuppression, or recent sexual activity. During this time, he was being treated for erythema nodosum when he developed worsening penile swelling and pain. Imaging (ultrasound and MRI) showed a lesion within the corpora cavernosa; surgical exploration and biopsy confirmed the presence of cavernous abscess, and the pus culture grew Acinetobacter wolffi, an organism not usually associated with penile infections. Surgically, the abscess was drained, and antibiotics were administered based on sensitivities. The patient made a good recovery without any residual symptoms, and follow-up demonstrated no effect on erectile function or scarring or curvature (both of which can be significant concerns in these cases). This case highlights the diagnostic challenges of cavernosal abscesses, particularly in the absence of typical risk factors. Early imaging and surgical intervention were crucial for a positive outcome. Urologists and primary care providers should maintain a high suspicion for such atypical presentations when evaluating unexplained penile swelling. To our knowledge, this is among the first reported cases of a spontaneous Acinetobacter wolffii-induced cavernosal abscess.