Acute Priapism as a First Manifestation of Chronic Phase CML; A Case Report

Abstract

Priapism is a urological emergency that, if not treated promptly, can result in erectile dysfunction. 50% of cases of priapism in leukemia are caused by chronic myeloid leukemia, but priapism is only observed in 3% of chronic myeloid leukemia and very infrequently as the initial manifestation. This is a case of a 28-year-old male with no prior co-morbid presented with acute penile erection for eighteen hours. The patient was vitally stable on examination and had a palpable spleen of 4cm below the left costal margin. Laboratory workup showed leukocytosis, low hemoglobin, normal platelets, and 2% myeloblasts on the peripheral film. Aspiration of the corpora cavernosa at the shaft of the penis was done and blood gas analysis showed acidosis, hypercarbia, and hypoxia consistent with ischemic priapism. Bone marrow aspirate showed chronic phase chronic myeloid leukemia. BCR-ABL by FISH showed p210 mRNA and the patient was started on Imatinib. Priapism in chronic myeloid leukemia is rare as the first presentation and requires urgent initiation of cytoreduction therapy to prevent worse outcomes.