Unusual Cause of Necrotizing Urethritis

We report a case of Wegener granulomatosis presenting as a destructive urethral mass. The initial clinical impression was carcinoma, and a urinary diverting procedure was consid- ered before the correct diagnosis was established. The importance of recognizing this unusual disease and its dramatic response to appropriate therapy are emphasized+ Wegener granulomatosis is a systemic vasculitis which involves primarily the lung and upper respiratory tract and is often associated with a focal glomerulonephritis. Involvement of other organ systems especially skin and central ner- vous system may occur, but lesions in the lower genitourinary tract are unusual. We report the development of a necrotizing urethritis due to Wegener granulomatosis two years following lung involvement at a time when there was no evidence of pulmonary recurrence or other ex- trapulmonary lesions. The difficulties in diag- nosing this unusual disease are discussed, and dramatic response to appropriate therapy is em- phasized.