Case Report |
Corresponding author: Emil Dorosiev ( emodorosiev@gmail.com ) © 2022 Emil Dorosiev, Boris Mladenov, Ivan Stoev, Dimiter Velev, Simeon Georgiev.
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Dorosiev E, Mladenov B, Stoev I, Velev D, Georgiev S (2022) Priapism in an otherwise healthy man with SARS-CoV-2: case report and literature review. Folia Medica 64(6): 1016-1019. https://doi.org/10.3897/folmed.64.e71053
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COVID-19 disease causes acute respiratory infection – pneumonia. It is associated with an increased risk of complications such as hypercoagulopathy, which leads to thromboses. We present a case of a young man presenting with typical SARS-CoV-2 symptoms (fever, cough, fatigue, and dyspnea), who experienced ischemic priapism, most probably due to thrombosis of penile vessels caused by the novel coronavirus infection. After prompt treatment of the priapism with punctures and irrigation, lasting penile detumescence was achieved. However, despite younger age, lack of serious comorbidities and administration of anticoagulants, priapism was followed by a fatal pulmonary embolism some days later.
hypercoagulopathy, priapism, SARS-CoV-2
Currently, the world is affected by an ongoing pandemic of a novel coronavirus causing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[
We present a case of a young male – 44 years old without any remarkable previous medical history. He presented with symptoms that started 5 days prior, which at the beginning were mild – subfebrile temperature, fatigue, headaches, muscle pain, light cough. He was started on paracetamol, vitamin supplements and azithromycin 500 mg once daily. Gradually, the cough increased and the day before admission to hospital, he felt shortness of breath and experienced erection of the penis without sexual stimulation. The erection persisted more than 15 hours and started to be painful and the dyspnea worsened, so he was referred to our hospital for evaluation. At admission, the laboratory results showed normal white blood cells (WBC), lymphopenia – 0.5 G/l, normal values of neutrophils, hemoglobin, and thrombocytes. Liver enzymes were slightly elevated, electrolytes and renal function – normal. CRP was elevated 25 times and INR – 1.32 (Table
Indicator, reference range | Hospital admission | Day 4 | Day 13 |
WBC, 4.1–11 G/l | 4.9 | 7.86 | 17.37 H |
Neutrophils, 2.0–7.8 G/l | 4.1 | 6.89 | 15.5 H |
Lymphocytes, 0.6–4.1 G/l | 0.5 L | 0.55 L | 0.89 |
Hemoglobin, 140–180 g/l | 177 | 157 | 148 |
Thrombocytes, 140–440 G/l | 164 | 485 H | 407 |
Urea, 2.8–7.2 mmol/l | 7.2 | 4.6 | 12.5 H |
Creatinine, 74–110 umol/l | 104 | 76 | 142 H |
Potassium, 3.5–5.1 mmol/l | 4.7 | 3.9 | 5.5 |
Glucose, 4.1–5.9 mmol/l | 7.17 H | 7.94 H | 16.24 H |
CRP, <0.50 mg/dl | 13.37 H | 18.29 H | 9.44 H |
ASAT, <50 U/l | 94 H | 66 H | 37 |
ALAT, <50 U/l | 141 H | 82 H | 35 |
Procalcitonin, <0.50 ng/ml | 0.4 | 1.11 H | 2.64 H |
D-Dimer, <500 ngFEU/ml | 832 | 601 H | 5600 H |
INR, 0.8–1.2 | 1.32 H | 1.46 H | 1.77 H |
Arterial blood gas analyses: from a. radialis – saturation (SpO2) 89%, pH 7.36; from corpora cavernosa of penis – SpO2 56%, pH 7.03.
Unenhanced CT scan indicated bilateral diffuse ground glass opacities in all lung segments – viral pneumonia affecting between 40% and 50% of the lung parenchyma. Fig.
Nasopharyngeal PCR test for COVID-19 – positive.
An ischemic priapism was diagnosed and immediate intervention under local anesthesia with lidocaine was performed – bilateral puncture of the cavernous bodies with blood aspiration, followed by irrigation with saline and heparin solution. The needle was gauge 21. Lasting detumescence was achieved right away and the episode of priapism was solved (Fig.
The treatment included saline infusions, antibiotics, gastroprotection, NSAIDs, methylprednisolone, enoxaparin 60 mg/0.6 ml once daily. At the beginning, oxygen (5 l/min) was given through an oxygen mask achieving SpO2 97% and improvement of his condition. After 5 days his condition started to decline and low saturation level despite prone position and maximal oxygen on face mask necessitated the application of high-flow oxygen non-invasive positive pressure ventilation (60 l/min; 90% O2). The subsequent radiological examinations showed worsening of the lung findings (Fig.
At 13 days after admission, the patient experienced chest pain, cyanosis and decline of saturation and his blood gas analyses, CT chest scan and D-dimers indicated bilateral submassive pulmonary thromboembolism. Heparin infusion treatment was initiated as instructed by consultation with a cardiologist. The patient’s condition rapidly declined the next day, he was intubated and died 8 hours later.
There are three types of priapism: ischemic “low blood flow” priapism, characterized by a minimal to absent arterial inflow, leading to pain and rigidity; non-ischemic “high blood flow”; and stuttering priapism.[
One of the serious COVID-19 disease complications is venous thrombosis. Overall thrombosis rate was reported to be 21% among hospitalized patients, in ICU – 31%; overall pulmonary embolism rate was 13%, in ICU – 19%.[
In our case the treatment of priapism was prompt right after the patient admission, which is important, as the time from onset to treatment is crucial for a successful outcome.[
Hypercoagulopathy in the course of SARS-CoV-2 is a relatively common complication leading to higher morbidity. One possible urological manifestation is ischemic priapism, which should be treated according to current practices, additional systemic antithrombotic therapy may be needed.