| Summary: | Pyoderma gangrenosum (PG) is an uncommon neutrophilic dermatosis that typically presents with painful ulcerative lesions, most often on the lower extremities. Genital involvement, particularly of the penis, is extremely rare and may clinically resemble infectious or necrotizing ulcers, leading to delays in diagnosis and inappropriate management. We report a 22-year-old uncircumcised male who presented with a progressive, painful penile ulcer unresponsive to multiple antibiotic courses. Clinical examination revealed a deep ulcer with irregular, undermined edges and purulent slough. Routine laboratory investigations, serology for sexually transmitted infections, wound cultures, and systemic evaluation were unremarkable. Histopathology demonstrated dense neutrophilic infiltration with granulomatous features, and a pathergy test was positive. The patient responded rapidly to oral corticosteroid therapy, with methotrexate introduced as a steroid-sparing agent, achieving complete healing within 8 weeks. This case underscores the importance of considering PG in persistent penile ulcers to enable timely immunosuppressive therapy and avoid mutilating surgical procedures.
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