Case 3: Priapism in a 13-year-old Boy

Abstract

A 13-year-old boy without a significant medical history presents with a painful erection that has persisted for 3 days. He denies any known stimulus, trauma, or new medications. He has not had any other symptoms except for vague headaches and leg pain in the past month. He has seen 2 providers in the past 3 days, who prescribed therapies including lidocaine, oral pseudoephedrine, and antibiotics without relief. No laboratory tests were obtained at either visit. On physical examination he is afebrile, his blood pressure is 146/76 mm Hg, and his heart rate is 117 beats/min. He appears uncomfortable from penile pain but is nontoxic. On abdominal examination, his spleen is palpable 4 cm below the costal margin, and his genitourinary examination reveals an erect penis that is erythematous, tender to palpation, and without any obvious perfusion defects. The remainder of his examination findings are normal. Pediatric urology is urgently consulted for management of priapism, and laboratory studies are sent, which reveal the etiology of his symptoms. Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: https://shop.aap.org/licensing-permissions/Reprints Information about ordering reprints can be found online: http:// classic.pedsinreview.aappublications.org/content/reprints AUTHOR DISCLOSURE Drs Clark, Hsu, Darves-Bornoz, Tanaka, Mason, and Katzenstein have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/ device.

The value of leukapheresis for treatment of priapism as presenting feature of chronic myeloid leukemia—Case report and review of literature

“…The mean WBC count was 365 × 10 9 /L (SD ±4.7), and median time to treatment was 3 days (Q1–Q3 1–5). Ten patients reached detumescence after treatment, one patient experienced still phallus rigidity and tenderness after treatment, and for one patient this was not reported [3, 32].…”

“…In these cases, time to treatment consisted of, respectively, 2 and 10 days, with WBC in higher ranges, 320 × 10 9 and 420 × 10 9 /L. A total of seven patients received shunt surgery, five after unsuccessful detumescence after penile aspiration and injection [30,32,33,47,50]. Two patients were treated with a third modality and received penile radiation therapy [40,49].…”

“…Some case reports reported start of treatment with chemotherapy or TKI when diagnosis of CML was established. Five cases used leukapheresis, the amount of sessions performed is not reported [3,32,40,46,49]. In 85% of the patients, detumescence was reached after treatment, 15.4% (n = 4) reported ED.…”

“…A total of 11 reports used leukapheresis in treatment of the hyperviscosity causing priapism, consisting of 12 patients (Table 5). Eight case reports used leukapheresis in a combined treatment modality with urological interventions [25,30,32,40]. Three reports used only an oncological approach [12,13,18].…”

Priapism and chronic myeloid leukemia in an adolescent. Rare debut presentation. A case report

“…5 Only 1-5% of priapism cases are caused by some type of leukemia and, of these, half of the priapism cases are associated with CML. 1,5,8 The most common cause of priapism in children is sickle cell anemia (65%), followed by leukemias (10%), trauma (10%), idiopathic origin (10%), and medications (5%). 3,8 Here we describe the case of a patient who presented with priapism as the initial manifestation of CML, its course, and management.…”