包皮硬化性苔癬：易被忽略之糖尿病前兆

陳妤甄¹、陳浩瑋¹、蔡嘉駿^{1, 2}、阮雍順^{1, 2}

高雄醫學大學附設醫院 泌尿部¹；高雄市立大同醫院 泌尿科²

Preputial Lichen Sclerosus: A Rare and Easily Ignored Initial Clinical Presentation of Newly Diagnosed Diabetes Mellitus

Yu-Chen Chen¹, Hao-Wei Chen¹, Chia-Chun Tsai^1,2 ,Yung-Shun Juan^1,2

Divisions of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan ¹

Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan ²

A 26-year-old man presented to the urological department with a 1-month history of recurrent linear lacerations on the prepuce. For 2 months before presentation, he complained of difficulty of retracting the prepuce but had no dysuria or urethral discharge. Although he was obese (height: 176 cm; weight: 129 kg; body mass index (BMI): 41.9 kg/m2), his medical history was unremarkable. Physical examination revealed loss of elasticity of the prepuce. Multiple linear lacerations appeared when he tried to retract the prepuce (Figure 1). He also had fungal balanoposthitis, which presented as white plaques with shallow ulcers on the glans. The patient had a regular sexual partner and tested negative for infections with human immunodeficiency virus, syphilis, and hepatitis virus. He denied any history of previous systemic diseases. Laboratory studies revealed a high fasting blood glucose level (256 mg/dL). Newly diagnosed diabetes mellitus (DM) was confirmed by the elevated HbA1c level (8.7%). Intensive cleaning, lifestyle modification, and oral metformin were prescribed. Although DM was under control (HbA1c level, 6.5%), the tight prepuce persisted for 3 months thereafter. Circumcision was performed, and histological examination of the specimen revealed preputial lichen sclerosus and atrophicus. The patient had complete remission within the next 7 days.

Preputial lichen sclerosus is a rare, chronic inflammatory dermatosis of unknown cause and is associated with increased BMI and higher prevalence of concomitant DM 1. We hereby report a rare and easily ignored case of preputial lichen sclerosus as the initial clinical presentation of a newly diagnosed DM. In clinical practice, thorough evaluation and control of underlying diseases, followed by surgical management, are recommended. It is important that all patients with this rare presentation should be surveyed for underlying diseases, especially newly diagnosed or poorly controlled DM.