LAUSR

A 35-year-old male with a history of diabetes presented to the emergency department with a persistent fever and weakness after discontinuation of insulin therapy. The patient had a neurogenic bladder and an indwelling transurethral catheter. His vital signs revealed a diaphoretic febrile male with hypotension and tachycardia. The physical examination showed a phimotic penis with periurethral necrosis, and a nonfunctional Foley catheter in place. Local examination of the genitalia revealed an oedematous and tender scrotum with no crepitus to palpation. A Foley catheter replacement was performed for a three-way catheter to irrigate the bladder, obtaining turbid urine output with necrotic debris. Complete blood count revealed an elevated white blood cell count, with 85% neutrophils. Blood culture tested positive for Klebsiella pneumoniae susceptible to carbapenem. A simple abdominal tomography was performed, finding the presence of gas in the prostatic tissue (Figure 1). Broad-spectrum antibiotics were initiated. The patient underwent a cystoscopy that revealed necrosis of the urethral mucosa and a perforating lesion in the prostatic region. Because of the extension of necrosis in the urethra and penile tissues, a penectomy and suprapubic catheter were performed. After 15 days of broad-spectrum antibiotics, the patient was afebrile with overall clinical improvement. A simple tomography was performed, showing no evidence of gas within the prostatic region.