A 3 year old male presents with the chief complaint of “privates swollen.” He was previously well until today, and after itching in his underpants in the morning mom checked and saw that her son had “Crazy swelling of his wee wee.” He has been able to void normally, and denies pain. He is afebrile and has not had any vomiting or diarrhea. There is no history of trauma. He likes to play outside in the yard, and was doing so all day yesterday.

On exam everything is normal, except his genitals…

via http://www.pediatricurologybook.com/

What is the diagnosis?

Summer Penile Syndrome

The appearance is pathognomionic – and it has also been called seasonal acute hypersensitivity reaction, and lion’s mane penis. It is usually the result of chigger bites. Most patients experience pruritis (84%) and 4/5 had recent exposure to the woods, park, lawn, or poison ivy. According to a 1988 study in Pediatric Emergency Care Smith et al noted that one-third had dysuria – but I’ve found this number to be much lower in my practice.

Almost all patients will have penile edema, most marked at the skin near the base of the glans. Half might have a small papule or bug bite.  Treatment consists of an oral antihistamine and cold compresses. You can consider a dose of IV for PO dexamethasone 0.6mg/kg up to 10mg max if the child is in pain or is having trouble with the voiding stream. Symptoms (both swelling and pruritis)can last up to 2 1/2 weeks, but most patients have resolution by day 5. It should be differentiated from trauma, nephrotic syndrome, HSP, balanitis, phimosis, paraphimosis and priapism. Urology involvement and referral is usually not necessary.