Jain Natasha A, Venkatesan Krishnan, Anandi Prathima, Ito Sawa, Kumar Dhruv, Lu Kit, Battiwalla Minoo, Barrett A John
Hematology Branch, NHLBI, National Institutes of Health, Bethesda, MD, USA.
Department of Urology, Medstar Washington Hospital Center, Washington DC, USA.
Arch Cancer Res. 2015;3(2). doi: 10.21767/2254-6081.100018.
Chronic graft versus host disease (GvHD) after allogeneic stem cell transplantation (SCT) may involve any organ system, but male genital involvement is rare. Peyronie's Disease (PD) is an acquired, localized fibrotic disorder of the tunica albuginea, which leads to penile deformity, pain, and eventually to erectile dysfunction. We report the case of a 52 year old African American male with Acute Myeloid Leukemia who underwent human leucocyte antigen (HLA) matched sibling allogeneic peripheral blood SCT. His post transplant course was complicated by development of acute and multi-organ chronic GvHD requiring prolonged immunosuppression. He developed progressive dorsal curvature of the penis with erections within 1 year of ultra low dose interleukin -2 (IL2) treatment for his chronic GvHD but concealed symptoms for several months. Color Doppler Duplex ultrasound evaluation of the erect penis revealed a 75-degree curvature and appropriate hemodynamic response to prostaglandin injection. He underwent successful incision and grafting of the penile plaque. There is no significant residual curvature and is now able to engage in intercourse. A strong temporal association between GVHD (or its treatment) and Peyronie's is documented here. Awareness of the possible link between PD and chronic GVHD is required in this era of rapid growth in numbers of SCT.
异基因干细胞移植（SCT）后的慢性移植物抗宿主病（GvHD）可能累及任何器官系统，但男性生殖器受累情况罕见。佩罗尼氏病（PD）是一种后天获得的白膜局限性纤维化疾病，可导致阴茎畸形、疼痛，并最终导致勃起功能障碍。我们报告了一例52岁的非裔美国男性急性髓系白血病患者，他接受了人类白细胞抗原（HLA）匹配的同胞异基因外周血SCT。他移植后的病程因急性和多器官慢性GvHD的发生而复杂化，需要长期免疫抑制治疗。在接受超低剂量白细胞介素-2（IL2）治疗慢性GvHD的1年内，他出现阴茎勃起时渐进性背曲，但隐匿症状数月。对勃起阴茎进行彩色多普勒双功超声评估显示有75度弯曲，对前列腺素注射有适当的血流动力学反应。他接受了阴茎硬结的成功切开和移植手术。目前无明显残余弯曲，现在能够进行性交。本文记录了GvHD（或其治疗）与佩罗尼氏病之间强烈的时间关联。在SCT数量迅速增长的这个时代，需要认识到PD与慢性GVHD之间可能存在的联系。
