Differential Diagnosis for Penile Swelling
The patient presents with a four-week history of swelling to the left penile corpus cavernosum, which is painful on erection and restricts erection. Considering the recent treatment for gonorrhea, the differential diagnosis can be categorized as follows:
- Single most likely diagnosis
- Peyronie's disease: This condition is characterized by the formation of fibrous scar tissue within the penis, leading to painful erections, curvature, and restriction of erection. The recent history of gonorrhea could be a triggering factor, and the symptoms of painful erection and restriction of erection align with Peyronie's disease.
- Other Likely diagnoses
- Corpus cavernosum hematoma: Although the patient denies snapping, a hematoma could still be a possibility, especially if the patient had recent trauma or vigorous sexual activity. The swelling and pain on erection could be indicative of a hematoma.
- Chronic corporal fibrosis: This condition could be a result of the recent gonorrhea infection, leading to fibrosis and scarring within the corpora cavernosa, causing painful erections and restriction of erection.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Penile cancer: Although rare, penile cancer could present with a painful swelling, and a delay in diagnosis could be devastating. It is essential to rule out this possibility, especially in the presence of a recent gonorrhea infection, which could be a cofactor.
- Corporal abscess: An abscess within the corpora cavernosa could be a complication of the recent gonorrhea infection, and if left untreated, could lead to severe consequences, including sepsis.
- Rare diagnoses
- Cavernosal thrombosis: This condition is rare but could present with sudden onset of painful erection and swelling. It is essential to consider this possibility, especially if the patient has a history of coagulopathy or recent trauma.
- Sarcoidosis: This systemic disease could affect the penis, leading to granulomatous inflammation and fibrosis, causing painful erections and restriction of erection. Although rare, it is essential to consider this possibility, especially if the patient has a history of sarcoidosis or other systemic diseases.