An unusual cause of genital swelling
R Corso, *P Ellul, M J Boffa; Department of Dermatology, Sir Paul Boffa Hospital, Malta & *Division of Gastroenterology, Department of Internal Medicine, Mater Dei Hospital, Malta
Genital swelling can develop acutely, sub-acutely or chronically and can be secondary to a variety of different medical and surgical causes. Specifically in men, non-painful subacute and chronic genital oedema can pose a diagnostic conundrum. We present the case of a 25-year-old man with a four-year history of increasingly severe and persistent penile and scrotal swelling. Skin biopsies showed granulomatous inflammation. Blood investigations revealed a mild anaemia with folate and iron deficiency. On questioning, the patient also admitted to a history of change in bowel habits and bleeding per rectum. For this reason he underwent an oesophago-gastro-duodenoscopy and colonoscopy which showed raised perianal lesions, aphthous ulceration throughout the colon, and tightening and inflammation of the ileo-caecal valve. Colonic biopsies showed numerous discrete non-necrotising granulomas. These investigations thus supported the impression of Crohn’s disease with extra-intestinal metastatic involvement of the genitals as the cause of the genital swelling. The patient was treated for Crohn’s disease with oral prednisolone, azathioprine and infliximab with subsequent improvement in the swelling. Crohn’s disease is a very uncommon cause of non-ulcerated penile and scrotal oedema but one which should nonetheless be considered by the clinician when faced with this presentation.