Balanitis: a wake-up call (case report)
DOI:
https://doi.org/10.32385/rpmgf.v41i2.13998Keywords:
Balanitis, Candida albicans, Diabetes mellitus type 2, Case reportAbstract
Introduction: Balanitis is an inflammation of the glans penis often caused by C. albicans. Its diagnosis is clinical and it can be recurrent or resistant to pharmacological therapy, which should lead us to suspect occult diabetes mellitus. This case poses a diagnostic challenge, as it is now possible to diagnose diabetes long before these skin changes occur.
Description: The case report is about a 59-year-old male patient who reported penile irritation, increased sensitivity, phimosis of the foreskin, erectile dysfunction with intense pain, and penile erythema when having sex. Once the diagnosis of balanitis had been made, the patient began multiple antifungal/antimicrobial treatments (fluconazole, dexamethasone, and clotrimazole combination cream) to which resistance was observed. Because of this, about three months after the onset of symptoms, the diagnostic hypothesis of occult diabetes was raised, and the diagnosis was confirmed by fasting blood glucose. He was started on insulin and terbinafine, with symptomatic improvement and a reduction in glycemic values.
Comment: When faced with a case of balanitis that is resistant to pharmacological treatment, it is essential to be highly suspicious of a possible diagnosis of occult diabetes, and to include it as a differential diagnosis, regardless of any screening previously carried out. Family doctors are in a privileged position to recognize balanitis as a cutaneous manifestation of diabetes to make a timely diagnosis and prevent possible complications.
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