PSD04 Painless penile ulceration in a pig farmer

Abstract

A 43-year-old man presented to the dermatology clinic with a 16-day history of penile lesions. He had been working on a pig farm, with over 5000 pigs, for 6 weeks under unhygienic conditions. His duties included handling pig carcasses, dosing animals with antibiotics and marking them post-treatment, without any formal veterinary training or personal protective equipment. He reported frequent contact of his genital area with his contaminated hands while urinating on the farm; bathroom facilities were distant and work demands were high. The initial symptom was nocturnal pruritus in the pubic region, associated with irritation resembling a shaving rash. This progressed to the development of erosions over the dorsal penile shaft, which subsequently coalesced into a black eschar. The patient reported that the lesions were painless. He had received a 10-day course of flucloxacillin and doxycycline at another hospital prior to presentation. He denied recent sexual activity, and his past medical history was unremarkable. His social history was notable for smoking 20 cigarettes per day and minimal alcohol consumption. On examination, multiple eschars were present over the dorsal penile shaft, with mild surrounding erythema and minimal induration. Similar punched-out lesions were observed on the mons pubis but no additional lesions were observed elsewhere. A biopsy of the lesion was performed for histopathology and tissue culture. Histopathological analysis demonstrated ulceration with a surface neutrophilic exudate containing numerous Gram-positive cocci, along with a secondary perifollicular and periadnexal chronic inflammatory infiltrate. Tissue culture grew Staphylococcus aureus, resistant to clindamycin and tetracycline but sensitive to flucloxacillin and methicillin. This methicillin-­sensitive S. aureus was negative for Panton–Valentine leucocidin cytotoxin. This case illustrates the risk of localized staphylococcal inoculation in the setting of poor hygiene and occupational exposure in pig farming, highlighting the importance of protective measures and proper hygiene in preventing cutaneous infections among agricultural workers dealing with livestock.