A 56-year-old male solid organ transplant recipient, on immunosuppression, presented with a penile lesion. Initial investigations for common causes were negative. Biopsy of the lesion revealed granulomatous inflammation, and subsequent PCR identified Mycobacterium tuberculosis complex. Further imaging confirmed miliary tuberculosis. This atypical presentation of penile tuberculosis served as the initial manifestation of disseminated disease in an immunocompromised patient. The patient was successfully treated with anti-tuberculosis therapy. This case highlights the diagnostic challenges and importance of considering disseminated tuberculosis in transplant recipients with unusual lesions.
Key note: Atypical presentations of tuberculosis, like penile lesions, can be the first sign of disseminated disease in immunocompromised solid organ transplant recipients.