Uploaded July 2026 | Updated September 2026, 1 week ago
A 42-year-old man on prolonged immunosuppressive therapy for chronic graft-versus-host disease after stem-cell transplantation for acute lymphoblastic leukemia presented to clinic with a 2-week history of urinary frequency and weak stream. Physical examination was notable for several small papules on the penile shaft. Urinalysis showed 9 white cells per high-power field, and a urine culture was negative. Testing for human immunodeficiency virus was also negative. Resected urethral tissue showed papillomatous squamous proliferation with koilocytic atypia. What causes this condition? Submit your answer at NEJM.org (link in bio).
#nejm
A 42-year-old man on prolonged immunosuppressive therapy for chronic graft-versus-host disease after stem-cell transplantation for acute lymphoblastic leukemia presented to clinic with a 2-week history of urinary frequency and weak stream. Physical examination was notable for several small papules on the penile shaft. Urinalysis showed 9 white cells per high-power field, and a urine culture was negative. Testing for human immunodeficiency virus was also negative. Resected urethral tissue showed papillomatous squamous proliferation with koilocytic atypia. What causes this condition? Submit your answer at NEJM.org (link in bio).
#nejm
