Penile Necrosis in a Patient With Untreated Crohn’s Disease

Question: A 64-year-old Caucasian man with a history of untreated ileocolonic Crohn’s disease and hypertension initially presented to an outside hospital for generalized weakness. He was found to have a severe acute kidney injury (AKI) with a peak creatinine of 14.8 mg/dL, hyperphosphatemia (phosphorous 17.8 mg/dL), and hypocalcemia (calcium 5.8 mg/dL). He was found to have multiple bilateral distal ureteral stones and his AKI resolved after ureteral stenting. The patient’s hypocalcemia was attributed to secondary hyperparathyroidism (parathyroid hormone [PTH], 334 pg/mL) in the setting of renal disease and vitamin D deficiency (vitamin D-25-OH, 6 ng/mL); he was treated with calcitriol, vitamin D, and calcium carbonate.