An 18-month-old male with a history of prematurity (31 weeks gestation) presented with acute onset swelling of the penile shaft. The patient had mild congestion and cough 2-3 days prior to presentation, otherwise was in his normal state of health. Parents noted redness and swelling of the skin on the penile shaft on the day of presentation. No new exposures (lotions, soaps, detergents, diapers, foods, etc). He seemed to have pain with urination but had the same number of wet diapers. No fevers, vomiting, diarrhea, constipation, cough, or other rashes.
Vitals: BP 92/56; Pulse 124; Temp 37 °C (98.6 °F) (Axillary); Resp 32; Wt 10.4 kg (22 lb 14.9 oz)
Constitutional: Active and moving around the room.
Abdomen: Flat and soft. There is no abdominal tenderness.
Genitourinary: Circumcised. Swelling and redness of the skin of the shaft of the penis. Glans is unaffected. No scrotal swelling. Bilateral testicles palpable, non-tender.
Skin: Warm
Non-contributory
a. Phimosis: This occurs when the prepuce cannot be retracted due to natural adhesions between the glans and the prepuce.
b. Paraphimosis: Paraphimosis is the acute swelling and inflammation of the distal penis and glans due to a constricting force. This is a medical emergency that requires emergent treatment.
c. Balanoposthitis: Balanoposthitis is the inflammation of the glans (balanitis) and the foreskin (posthitis) due to bacterial, fungal, or viral infections.
d. Summer Penile Syndrome: This is a seasonal hypersensitivity reaction to insect bites or contact dermatitis.
e. Penile Cellulitis: Bacterial infection of the penile tissues resulting in erythema, pain, swelling, and fever, usually due to gram-positive bacteria.
In the setting of recent viral symptoms (cough and congestion), he was diagnosed with viral penile inflammation. Treatment consists of supportive care with liberal use of topical emollients and barrier creams. Oral antihistamines were recommended as needed.
Take-Home Points
- Penile inflammation is a common complaint in pediatric emergency patients.
- Treatment is usually supportive, but it is important to recognize medical emergencies, like paraphimosis.
- Castagnetti M, Leonard M, Guerra L, Esposito C, Cimador M. Benign penile skin anomalies in children: a primer for pediatricians. World J Pediatr. 2015 Nov;11(4):316-23. doi:10.1007/s12519-015-0015-5. Epub 2015 Mar 9. PMID: 25754752.
- Chan IH, Wong KK. Common urological problems in children: prepuce, phimosis, and buried penis. Hong Kong Med J. 2016 Jun;22(3):263-9. doi: 10.12809/hkmj154645. Epub 2016 May 6.PMID: 27149978.
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