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Case of the Month - September 2011

Frans Radebe, NICD

A 49-year old man presented to Alexandra Men’s clinic, Gauteng on the 13/08/2011 with a swollen penis of one month duration, associated, swollen, enlarged testes and swollen legs. Originally from Tzaneen, Limpopo, he lives in Johannesburg, visiting home on a monthly basis. He had not travelled outside of South Africa. His HIV status was unknown (he refused testing) and he was unwilling to give a sexual history, other than the fact that his last sexual encounter was 1 month previous with a single partner. He denied trauma to the penis, genital ulceration or penile discharge. On examination, he manifested a ‘Saxophone- like penis” (figure 1), which was cold, non-tender, enlarged and curved. There was no urethral discharge, penile or perianal ulceration, or regional lymphadenopathy. The scrotum was huge and swollen and testes were unpalpable. He had bilateral pitting oedema of the legs and his blood pressure was 157/94 mmHg. The rest of the examination was unremarkable.

The attending physician ruled out sexually transmitted infections (STIs) such as syphilis, lyphogranuloma venereum (LGV) and donovanosis on the basis of there being no clinical evidence of genital ulceration or urethral discharge. The patient was referred to a urologist for further assessment and treatment.

Figure 1 Genital elephantiasis resembling a “saxophone penis”

Question 1: What is the differential diagnosis of “Saxophone” penis?

Continue to Answer 1