Penile Telescoping, Dermatological and Multisystem Adverse Effects of Lithium Therapy in a Middle-aged Man: A Case Report in a Resource-Limited Setting

Abstract

Background: Lithium is the gold standard in the management of bipolar affective disorder (BAD). This case is unique because it involves multiple lithium adverse effects in a patient on long-term lithium therapy, showcasing a rare dermatological and genital complication. It has longitudinal laboratory monitoring of lithium assays and describes the complex interplay of factors that led to the rare genital complication. Method: Information was derived from his medical records, clinical interview, in-patient and out-patient records, multidisciplinary management, and serial lithium levels assessed at intervals of not more than 3 months. Also, electrocardiograms, thyroid function tests, renal function tests, and other investigations spanning across 8-10 years of follow-up were conducted. WHOQOL-BREF assessed his quality of life. This was followed by correlating temporal changes in serum lithium levels and clinical findings to assess patterns of lithium toxicity. Specialist evaluations from general medical practice, urology, cardiology, dermatology, neurology, and nephrology were extrapolated to characterize the multisystemic manifestations and rare complications. Informed consent was obtained from the patient for the publication of this report including the patient's perspective, while his personal information has been anonymized and de-identified. This report was prepared following the Case Report (CARE) guidelines. Results: Genital findings include marked scarring of the penile shaft and penile telescoping, while dermatological examination revealed psoriatic plaques in the genital area, umbilical region, and prominent silvery scaling on both elbows. Metabolic effects include truncal obesity, subclinical hypothyroidism, and Blood pressure changes. There was evidence of chronic kidney disease with an eGFR of 56ml/min/1.73m². The chronic burden of these multisystem side effects led to a reduced quality of life. However, serum lithium levels showed values within the therapeutic range, despite these adverse effects. Conclusion: This report demonstrates that chronic lithium therapy exposure influences morbidity, with the patient developing progressive multi-organ effects despite serum lithium levels within therapeutic range. This underscores the need for proactive clinical inquiry about the multiple systems during lithium therapy, irrespective of the tolerated therapeutic dose.