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Stem Cell Transplantation

Foscarnet-Induced Penile Ulceration

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1 Credit CME

JAMA Dermatology

Published Online: August 30, 2023

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Article Information and Disclosures

Justin D. Arnold, MD, MMSc¹;

Janellen Smith, MD¹

Author Affiliations

¹Department of Dermatology, University of California, Irvine

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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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Article Information

Corresponding Author: Justin D. Arnold, MD, MMSC, Department of Dermatology, University of California, Irvine, One Medical Plaza Dr, Irvine, CA 92697 (arnoldjd@hs.uci.edu).

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.

References

Adalsteinsson JA , Pan M , Kaushik S , Ungar J . Foscarnet-induced genital lesions: an overview with a case report. Dermatol Reports. 2018;10(1):7749. doi:10.4081/dr.2018.7749 PubMed Google Scholar Crossref

Torres T , Fernandes I , Sanches M , Selores M . Foscarnet-induced penile ulceration. Acta Dermatovenerol Alp Pannonica Adriat. 2011;20(1):39-40.PubMed Google Scholar

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.