Chronic lymphocytic leukemia and Priapism: An Unusual association

Priapism is a prolonged penile erection, unrelated to sexual arousal. It can lead to permanent tissue damage if not promptly managed. While it is more commonly associated with hematologic disorders such as sickle cell disease and hypercoagulable states, priapism in chronic lymphocytic leukemia (CLL) is exceptionally rare. There are few published case reports regarding CLL presenting with priapism as initial manifestation of the disease. This is a case of a 67-year-old male with CLL on monitoring, presented to the ED with priapism and further evaluation revealed a WBC count of 186.9 k correlating to his CLL diagnosis. The priapism was initially thought to be secondary to trazodone and was subsequently discontinued. The patient presented again in 2 weeks with priapism despite discontinuing trazodone with an elevated WBC count of 246.6 k, uptrending WBC count. The priapism was considered to be secondary to CLL, further imaging revealed extensive lymphadenopathy in the chest and upper abdomen (largest lymph node 2.7 cm). He was started on Obinutuzumab and responded well with a decrease in WBC count to 6.65 k after just one dose of Obinutuzumab. The priapism was resolved successfully without recurrence. The patient is currently being treated with Obinutuzumab and Venetoclax. Priapism can be a sign of progression as seen in the above case or as an initial manifestation of CLL. It happens due to leukostasis, where high leukocyte counts cause blood stasis in the penile vasculature. Hyperviscosity and leukemic cell infiltration of penile tissue may further contribute to blood flow obstruction, leading to priapism. This case emphasizes the need to consider hematologic malignancies, such as CLL, as potential causes of priapism in patients with high WBC counts. Immediate intervention is essential to prevent permanent penile damage. • Priapism secondary to CLL is a rare association • Diagnosis and management of CLL in time plays a key role in preventing complications • Priapism can be an initial presentation or manifestation of progression in CLL patients • Leukemias should be considered in patients with priapism with abnormal cell counts.