A man in his 60s with acute lymphoblastic leukemia presented to the dermatology department for recurrent painful penile ulcerations. The patient had recently undergone a haploidentical stem cell transplant, and his posttransplant course was complicated by pancytopenia and recurrent ganciclovir-resistant cytomegalovirus (CMV) viremia that required treatment with multiple courses of intravenous foscarnet therapy. Physical examination revealed an uncircumcised male individual with tender perimeatal erythema and ulceration extending to the right glans (Figure). No vesicles or lymphadenopathy were observed. Multiple herpes simplex virus polymerase chain reaction swab results were negative, along with a viral culture swab for CMV and screening for HIV, syphilis, gonorrhea, and chlamydia. A closer examination of the patient’s history revealed that the perimeatal ulceration occurred within a few days of the initiation of each course of foscarnet. A clinical diagnosis of foscarnet-induced penile ulceration was made given the temporal association of his symptoms with foscarnet administration, classic perimeatal distribution, and negative infectious workup results.
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Corresponding Author: Justin D. Arnold, MD, MMSC, Department of Dermatology, University of California, Irvine, One Medical Plaza Dr, Irvine, CA 92697 (email@example.com).
Published Online: August 30, 2023. doi:10.1001/jamadermatol.2023.2592
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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