Penile Mondor's disease: Imaging in two cases

Penile Mondor's Disease Resulting From Forceful Condom Removal During Sexual Intercourse: A Case Report and Literature Review

Penile Mondor's disease, or dorsal vein thrombophlebitis, is vital for urologists to recognize. It causes pain and hardening in the penis due to triggers like trauma or neoplasms. Distinguishing it from similar conditions such as sclerosing lymphangitis and Peyronie's disease is crucial. Penile Doppler ultrasound is the preferred diagnostic method. Providing reassurance can ease patient anxiety. This case report highlights a unique occurrence following forceful condom removal during sex, detailing symptoms, diagnosis, and successful treatment.

An unusual presentation of penile Mondor's disease in an HIV-positive patient

Penile Mondor's disease (PMD), or thrombosis of the dorsal vein, is an under-reported benign condition. Its aetiology is poorly understood. Clinically, it presents as a palpable cord in the dorsal vein of the penis, with pain or local discomfort, especially during erection. PMD may be diagnosed based on the medical history and physical examination. Management of the condition is conservative, with practitioners opting for various strategies including sexual/masturbatory abstinence, localised anticoagulant topical therapy and oral nonsteroidal anti-inflammatory drugs. In many cases, PMD will resolve within 4-8 weeks of presentation. Thrombectomy and resection of the superficial penile vein are applied surgically in patients refractory to the medical treatment. We describe the case of a 33-year-old patient known to have HIV who presented for severe painful dorsal induration and swelling of the proximal third of the penis. The patient had no recent history of sexual intercourse, penile trauma or other well-known risk factors for PMD. The physical examination was unequivocal, so a Doppler ultrasound was performed. A diagnosis of PMD was made and conservative treatment was prescribed. During a follow-up visit after 6 weeks, the patient had no symptoms and physical examination did not reveal anything pathological.

COVID-19 infection as a new risk factor for penile Mondor disease

Background

Penile Mondor disease is a superficial dorsal vein thrombophlebitis of the penis, which mainly affects young and middle-aged men. It generally manifests as a visible painful cord located along the dorsal surface of the penis with signs of skin inflammation. The condition is usually self-limiting, but in severe cases a surgical procedure may be necessary in addition to pharmacological treatment. Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is associated with a frequent incidence of thrombophilia; therefore, such a prothrombotic state during infection may be a significant risk factor for penile Mondor disease.

Case presentation

The 34-year-old patient reported moderate pain felt on the surface of the penis. During the medical interview, the patient did not admit significant risk factors for Mondor Disease, apart from the previous, a month earlier COVID-19 disease. Examination revealed swelling erythema and a thick indurated cord on the surface of the penis. Color Doppler ultrasound was performed to confirm assumptions and exclude thrombosis of other penile vessels. Based on visible clots in the course of the superficial penile vein and after exclusion of vasculitis due to autoimmune disease the diagnosis of penile Mondor disease was made. Pharmacological therapy was implemented to further break down the clot and prevent rethrombosis in the penile vessels. The patient did not report any treatment complications and returned for a control visit, which revealed complete clot dissolution on ultrasound; therefore, complete recovery was stated.

Conclusions

This case report presents the correlation between SARS-Cov-2 infection and penile Mondor disease, based on the confirmed influence of COVID-19 on the pathophysiology of thrombosis. It can be concluded that COVID- 19 is a risk factor for Mondor disease, as in the presented case the virus was the only prothrombotic risk factor for the patient. Consequently, the possibility of developing thrombosis in the form of penile Mondor disease should be taken into account among patients with post-COVID-19 and active SARS-Cov-2 infection.