Priapism is more commonly thought as a result of sex-enhancing drugs abuse or in spinal injury. We present such case in an unsuspecting teenager which turns out to be an uncommon manifestation of underlying disease.
A 16 years old boy with no known medical illness presented to our centre with chief complaint of persistent erection. Patient initially went to Hospital Putrajaya (30 kilometres from our centre) and subsequently referred here. Patient had painful erection for a total period of almost 30 hours by the time we saw him. He denied taking any medications, promiscuity or any recreational drugs abuse. He claimed to only have taken olive oil supplement for many years. Otherwise patient had no abdominal pain or fever and passed urine normally. No history of easy bruising or bleeding tendency or hematological disorder in family. He denied any trauma or spinal injury as well. His vital signs were stable. Upon examination, patient was pale and but had no jaundice. There was large splenomegaly extending to umbilical area. His penis was rigid, enlarged and tender on palpation. Both testes were palpable and normal. His full blood count showed: wbc 421, hb 7.4, hct 24, platelet 957.Patient was immediately referred to the urology team and sent straight to operation theatre for cavernosa aspiration. Diagnosis of Priapism secondary to Chronic Myeloid Leukaemia was made.
LESSONS LEARNT & CONCLUSION
Priapism can be part of manifestation of chronic myeloid leukaemia apart from pallor, aberrant blood counts and enlarged spleen. In this case priapism is most likely caused by venous obstruction from microemboli or thrombi as well as hyperviscosity caused by the increased number of circulating leukocytes in mature and immature forms. Pallor and sky-high white cell and platelet count should alert managing team to diagnosis of hematological malignancy.