Miliary tuberculosis (MTB) represents a critical variant of tuberculosis wherein the causative bacteria— Mycobacterium tuberculosis or possibly a related strain that infects cattle and deer, Mycobacterium bovis—disseminate throughout the organism, forming tiny lesions. The term “miliary” originates from the 1700s, when a doctor observed that the spots were similar to millet seeds.
Although Mycobacterium can be airborne and are frequently located in the lungs, the bacteria can affect any part of the body. Nonetheless, penile tuberculosis is extremely uncommon. In reality, it is rare for tuberculosis to appear in the urinary and genital systems. Among the infections that arise in this area, penile infections constitute less than 1 percent.
However, considering the man’s lung condition and his immunocompromised state, this peculiar manifestation became their primary hypothesis—and subsequent tests validated it. Mycobacterium were detected in the man’s respiratory tract, and penile tissue also tested positive for the bacteria, although the tests could not determine which species of Mycobacterium it was.
The treatment for tuberculosis necessitates a course of multiple antibiotics, extending over several months. In this case, his treatment was tailored to a 12-month, four-drug regimen that would not interfere with his transplant.
Nevertheless, the penile lesion worsened before it improved. He developed a significant necrotic ulcer on the side of his penis, leading to deterioration of his foreskin. Surgeons had to surgically remove the dead tissue. After 10 months, his infection seemed to have resolved, and the lesion on his penis had shown signs of improvement.
Unexplained exposure
The manner in which the man acquired the infection remains uncertain. He informed doctors that he was unaware of any contact with tuberculosis patients and had not been in environments where the bacteria typically propagate, such as correctional facilities. It is possible that the bacteria had been dormant in his transplanted kidney.
