PRIAPISM AS THE RARE MANIFESTATION OF CHRONIC MYELOID LEUKEMIA: A CASE REPORT

Abstract

ABSTRACT

Introduction  :

Chronic Myeloid Leukemia (CML) is a chronic myeloproliferative disorder and a form of leukemia characterized by the increased and unregulated growth of myeloid cells in the bone marrow and the accumulation of these cells in the blood. Majority of undiagnosed patients may initially present to Primary Health Cares and Emergency Departments (ED) with classical symptoms of anemia, unresolved infections and bleeding tendencies. Priapism is a rare symptom, about 5% of leukemic patients, and is most likely caused by venous obstruction from microemboli/thrombi and hyperviscosity caused by the increased number of circulating leukocytes. 

Case Report   :

A 26-year-old male presented with priapism to ED of Hospital Sultanah Nur Zahirah, urgent Full Blood Count (FBC) and Full Blood Picture (FBP) taken showed features of underlying hematological malignancy as CML. Prompt referral to surgical team was done and he underwent cavernosal aspiration, which results in pain improvement however there was incomplete relief of erection, and he was immediately transferred to Hospital Raja Perempuan Zainab, Kota Bharu and Distal Corpus Spongiosum was done.

Discussion      :

Priapism is an andrological emergency, as the risk of impotence is 50% despite appropriate management. Priapism can either be idiopathic or secondary to several medical conditions including CML. Urgent FBC and FBP are the first diagnostic tools which can be obtained at emergency departments to help narrow down the cause of priapism which demand early intervention and treatment. Prompt urological referral and cavernosal aspiration is important for symptomatic relief and resolution of the obstructed blood flow.

Conclusion     :

In general, as priapism is one of the rare manifestations of CML, high index of suspicion is vital once encountered and urgent FBC and peripheral blood smear are the first diagnostic tools in emergency care settings and should be performed immediately to prevent delayed diagnosis and management.