Penile Mondor’s in a Covid-19 patient on prophylactic anti-thrombosis with rivaroxaban: a case report

Abstract

Background Penile Mondor’s disease (PMD) is thrombophlebitis of the superficial dorsal vein of the penis. Following the occurrence of thrombotic events in the affected veins, the lumen often becomes occluded with fibrin and inflammatory cells. A hyper-coagulative state is one of the underlying causes although most cases of PMD are idiopathic. Coronavirus disease-2019 infection (COVID-19) is associated with frequent thrombotic events. Inflammation and thrombosis play a central role in the course and outcome of COVID-19, which can predispose to both venous and arterial thromboembolism. In this report, we present a 33-year-old male patient diagnosed with PMD during the subacute phase of COVID-19 infection while on prophylactic antithrombotic treatment. Case Presentation A 33-year-old male patient was diagnosed as PMD which occurred during the subacute phase of COVID-19 infection, while he was on active treatment of COVID-19 by prophylactic antithrombotic Rivaroxaban 15 mg therapy and curative antiviral medication. There was no recent sexual intercourse or trauma to the genitals. His PCR test for COVID-19 had become negative, and antibody test was positive at the time of his PMD’s onset. Rivaroxaban was replaced by Enoxaparin (8000 IU/0.8 ml.), a low molecular weight heparin administered subcutaneously and twice daily. On the third day of this medication, all coagulative measurements returned to normal. PMD disappeared in the second week. Conclusion Low-dose Rivaroxaban 15 mg is not safe for some COVID-19-associated thromboembolism prophylaxis, and careful follow-up is critical due to the possibility of a wide range of pathologic thrombotic manifestations in COVID-19 infection.

Penile Mondor's Disease Resulting From Forceful Condom Removal During Sexual Intercourse: A Case Report and Literature Review

“…Although its pathophysiology remains incompletely understood, several known etiological factors exist [20]. Numerous potential causes have been identified in various studies, as summarized in Table 1 [3,7,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Our case report is the first in the literature to document PMD resulting from forceful condom removal during sexual intercourse.…”

“…Distinct from PMD, Peyronie's disease is characterized by subcutaneous sclerosing lesions with a distinctive curved shape and a history of penile trauma [32]. Additionally, two case reports have suggested a link between SARS-CoV-2 infection and PMD due to COVID-19's documented impact on thrombosis pathophysiology [33][34][35]. Moreover, in men with erectile dysfunction and a low International Index of Erectile Function (IIEF-5) score, PMD may exacerbate symptoms [41].…”

Urological Safety and COVID-19 Vaccinations

“…PMD is an uncommon disease characterized by thrombosis of the superficial veins of the penis [24]. Several cases of PMD have been reported in patients infected with the SARS-CoV-2 virus [25,26]. It is important to mention that the AstraZeneca ChAdOx1-S vaccine can cause in rare cases a hypercoagulable state, and for that reason, in some countries, no further administration of this vaccine was provided [27,28].…”

COVID-19 infection as a new risk factor for penile Mondor disease

“…It is probably associated with direct endothelial damage and inflammation factors such as cytokines and reactive oxygen species [ 15 ]. Although the most common thrombotic state of COVID-19 infection is deep vein thrombosis and pulmonary embolism, so far published isolated reports indicate that it can also manifest itself as thrombosis of the penis vessels [ 16 – 18 ]. Furthermore, a report shows that past COVID-19 penile vessel thrombosis can appear not only as PMD, superficial thrombosis of the dorsal penile vein, but also as deep thrombosis of the dorsal penile vein or circumflex vein [ 17 , 19 ].…”