Penile calciphylaxis is a rare and life-threatening complication of end-stage renal disease (ESRD), characterized by vascular calcification, tissue necrosis, and exceptionally high morbidity and mortality rates. This condition presents significant diagnostic and therapeutic challenges, with an estimated mortality rate exceeding 60% and a mean survival time of approximately 2.5 months. Unlike other forms of penile gangrene, such as Fournier's gangrene, the management of penile calciphylaxis remains controversial due to limited evidence supporting aggressive surgical interventions.

We report the case of a 51-year-old male with ESRD managed with peritoneal dialysis, type 2 diabetes mellitus, coronary artery disease, and peripheral arterial occlusive disease. The patient presented with a penile abscess following prior debridement and partial penectomy.(Figure 1) On admission, he exhibited a purulent penile wound but was afebrile. Shortly thereafter, he developed neurological symptoms suggestive of delirium, prompting antibiotic therapy for suspected infectious encephalopathy. His clinical course was further complicated by left lower extremity ischemia requiring emergent angioplasty and thrombolysis. Abdominal computed tomography revealed severe calcification of the penile blood vessels. (Figure 2)Despite maximal medical therapy, the patient’s condition deteriorated, culminating in sepsis, disseminated intravascular coagulation, and septic shock. After transitioning to comfort-focused care, he passed away within 24 hours of initiating palliative measures.

This case highlights the rapid progression and poor prognosis associated with penile calciphylaxis. Current management strategies are limited by a lack of clear evidence-based guidelines. While conservative measures such as wound care and normalization of calcium-phosphate metabolism are commonly employed, surgical interventions like penectomy have not demonstrated clear survival benefits. Emerging therapies such as sodium thiosulfate and hyperbaric oxygen therapy show promise but require further validation.

Penile calciphylaxis is an uncommon but devastating manifestation of ESRD that underscores the need for multidisciplinary care and individualized treatment approaches. The absence of definitive management protocols emphasizes the urgent need for further research to improve outcomes in this challenging condition.