Isolated Penile Gangrene as the First Presentation of Acute Monocytic Leukemia

Abstract Isolated penile gangrene is a very rare clinical presentation which should prompt us to look for an underlying pathology. We report a case of a 74-year-old man who presented to us with fatigue. He had an ulcer on the prepuce of his penis, for which he underwent circumcision after 1 week. Following this, he developed a non-healing ulcer on the glans penis a week later, which then progressed to gangrene with pus discharge from the glans penis. Preliminary workup showed severe anemia, leukocytosis, and pus culture grew Acinetobacter baumanii . On treatment with prompt antibiotics, blood transfusions, and a supra pubic catheter, his condition improved symptomatically along with his blood parameters. His peripheral smear showed neutrophilia with a marked shift to the left, suggestive of a leukemoid reaction. The diagnosis of acute monocytic leukemia was confirmed after a bone marrow biopsy. This is a case where penile gangrene was the initial manifestation of an underlying serious hematological malignancy. This case emphasizes the importance of probing into underlying systemic pathologies, such as hematological malignancies, in patients with penile gangrene. It also highlights the necessity for a multi-disciplinary team approach for its diagnosis and management.