Priapism as the initial presentation of chronic myeloid leukemia in a patient with cerebral palsy: A case report

Priapism is defined as a penile erection lasting more than four hours without stimulation. The majority of cases involve ischemic priapism, in which there is partial or complete absence of cavernosal arterial flow. Priapism is uncommon, with an estimated annual incidence of approximately 1.5 cases per 100,000 men. In chronic myeloid leukemia (CML) patients, leukostasis may occur, which can lead to priapism in 1-2% of cases. We present the case of a 21-year-old patient with a history of cerebral palsy who was brought to the emergency department by his family with priapism persisting for 13 hours. It was noted that the patient had experienced one prior episode of priapism a month earlier, which had resolved spontaneously. He had no history of trauma. On physical examination, extremity contractures related to cerebral palsy were noted, and the penis was observed to be erect. A venous catheter was inserted into the corpus cavernosum, dark-colored blood was aspirated, and blood gas analysis confirmed the diagnosis of ischemic priapism. The corpus cavernosum was irrigated with normal saline, and epinephrine was administered into both corpora cavernosa; however, priapism did not resolve. Laboratory tests revealed a white blood cell count of 581,760 /mm³. The patient was referred to the hematology department. Peripheral blood smear analysis confirmed the diagnosis of CML, and leukapheresis was performed three times within two days. Following normalization of the peripheral white blood cell count, penile detumescence was achieved, and no further episodes of priapism occurred. In conclusion, early diagnosis and a multidisciplinary approach improve the success of priapism treatment and reduce the risk of complications.