T -cell predominant balanitis in a traumatic tetraplegic patient: a case report

T-cell predominant balanitis is described in a 38 year old uncircumcised tetraplegic man whose presenting feature was non-progressive red lesions over the inner prepuce and the glans penis without signs of infection, phimosis, or meatal stenosis. There was no regional lymphadenopathy. He was not exposed to any of the high risk factors for human immunodeficiency virus infection. As the lesion did not respond to topical antibacterial, antifungal, and corticosteroid medications applied in that order, circumcision was performed. Following circumcision, the remaining lesion over the glans penis regressed completely over a period of 1 month. Histopathology of the excised prepuce revealed both areas of normal non-keratinizing squamous epithelium as well as areas with hyperplasia. No atypia was noted and Bowenoid changes were not seen. Immunohistochemical studies on the inflammatory infiltrate in the excised prepucial lesion using tissue proliferation markers (PCNA and MIB-1) revealed active proliferation of the band-like infiltrate shown by immunophenotyping (anti-human T cell, CD45RO, clone UCHL1 and L26, pan-B marker) to consist predominantly of T-cells, further supporting the hypothesis of a local immune-mediated inflammatory process as the final pathogenic mechanism of the penile lesion.