Recurrent Priapism Associated With Occupational Cocaine Exposure in a Patient With Sickle Cell Trait: A Case Report

Cocaine is an uncommon but recognized cause of ischemic priapism due to its potent sympathomimetic and vasoactive properties. Case reports involving ischemic priapism related to intentional parenteral, intranasal, intracavernosal, and topical cocaine have been documented. Recurrent priapism resulting from occupational exposure to cocaine powder, however, has not been previously described. We report the case of a 37-year-old African American man with sickle cell trait who presented to the emergency department at least six times within a 12-month time period with recurrent priapism. Each episode was successfully detumesced with corporal aspiration and intracavernosal phenylephrine. The patient consistently denied recreational drug use; however, he admitted to working in the illicit drug industry "bagging" cocaine. This case highlights an unusual instance of recurrent ischemic priapism secondary to occupational cocaine exposure. Clinicians should maintain a high index of suspicion for environmental and occupational sources of cocaine absorption in patients presenting with unexplained or recurrent priapism. This case also highlights the first reported occupational exposure as a cause of priapism.