Penile Atrophy and Urethral Stricture Following Pyoderma Gangrenosum: A Case Report and Review of the Literature

Background Pyoderma gangrenosum (PG) is a rare, chronic, neutrophilic dermatosis. Penile involvement is exceptionally uncommon and can lead to severe complications if not managed appropriately. Case Presentation We report a case of a 59-year-old man with a six-month history of dysuria and urinary incontinence. Seven years prior, he was diagnosed with penile PG based on clinical and histopathological findings and treated with oral methylprednisolone. The initial skin lesions improved rapidly, and the dose was tapered to a long-term maintenance dose. However, the patient subsequently developed progressive penile atrophy. Upon current presentation, physical examination and imaging studies revealed complete absence of the pendulous penis, severe atrophy of the remaining penile structures, bilateral hydronephrosis, and a panurethral stricture. The patient underwent total penectomy and urethrectomy. Postoperative pathology surprisingly revealed massive neutrophilic infiltration in the penile urethra, indicating ongoing inflammatory activity despite long-term corticosteroid therapy. Following surgery, therapy was transitioned to adalimumab (a TNF-alpha inhibitor), with no recurrence after one year of follow-up. Conclusion This case highlights that long-term corticosteroid therapy for penile PG may not suppress the underlying destructive inflammatory process in deeper tissues, potentially leading to catastrophic complications such as penile atrophy and panurethral stricture. It underscores the critical need for vigilant, long-term urological monitoring and early consideration of alternative or adjunctive steroid-sparing agents in the management of this condition.