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Penile gangrene in lung cancer.

Accepted 18 November 1996 A 41-year-old man was admitted to the emergency service with complaints of pain and swelling in right calf, dyspnoea and haemoptysis. Hypoxaemia and hypocapnia were identified on arterial blood gases analysis: P02 53.9 mmHg, pCO2 30.6 mmHg, 02 saturation 88.5% and pH 7.42. An infiltrative mass in the right lower lobe with mediastinal and hilar adenopathies was seen on chest X-ray and subsequently on computed tomography. Right popliteal vein thrombosis and pulmonary thromboemboli were diagnosed with Doppler ultrasonography and pulmonary ventilation-perfusion scanning, respectively. Basal prothrombin levels, activated partial thromboplastin time and blood counts were within normal limits. Anticoagulation was started with intravenous heparin and later with subcutaneous low molecular weight heparin. The patient improved and bronchoscopic transbronchial lung biopsy was performed which revealed bronchioloalveolar carcinoma. Chemotherapy was administered as cisplatin plus etoposide. A few days after completion of the treatment, the patient suffered from acute penile pain and cyanosis which progressed to gangrene (figure). Coagulation tests were as seen in the table. Over the next few days oliguric acute renal failure and distal femoral arterial embolism developed. Blood urea nitrogen and creatinine levels progressively increased. There was bilateral renal ischaemia on radionuclide renal scan. Sudden left leg pain, pallor, coldness and absent popliteal and pedal pulses led to the diagnosis of arterial embolism, which was confirmed with Doppler ultrasonography. The patient died due to respiratory insufficiency, shock, and subsequent cardiopulmonary arrest. At necropsy, multiple thromboemboli in peripheral organs including brain, kidneys, lung, left femoral artery, and penile vasculature were confirmed.