Case Report

Priapism as an initial presentation in Chronic Myeloid Leukemia (CML): a case report

Ni Luh Putu Herawati , Tjokorda Gde Dharmayuda

Ni Luh Putu Herawati
Hematology and Oncology Division of Internal Medicine Department, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Denpasar, Bali, Indonesia. Email: herawatiniluhputu@yahoo.com

Tjokorda Gde Dharmayuda
Hematology and Oncology Division of Internal Medicine Department, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Denpasar, Bali, Indonesia
Online First: April 30, 2021 | Cite this Article
Herawati, N., Dharmayuda, T. 2021. Priapism as an initial presentation in Chronic Myeloid Leukemia (CML): a case report. Intisari Sains Medis 12(1): 334-337. DOI:10.15562/ism.v12i1.986


Background: Priapism is a persistent, usually painful erection that lasts for more than four hours and occurs without sexual stimulation. Priapism is a rare clinical sign of Chronic Myeloid Leukemia (CML), with an incidence of 1-5 cases per 100,000 people per year. In men who suffer from CML, ischemic priapism occurs secondary to hyperleukocytosis and venous obstruction by thrombus and microthrombus.

Case Presentation: In this case, a 24-year-old male, a Balinese ethnicity, present with prolonged erectile complaints accompanied by increased pain. From the examination performed, it was concluded that the patients had the ischemic type of priapism. From CBC, the patient was obtained hyperleukocytosis and continued with peripheral blood smear and bone marrow puncture. The patients concluded with CML, and initial intervention includes therapeutic aspiration, irrigation, hydroxyurea and other supportive therapies. It is a urological emergency requiring urgent treatment to prevent long-term complications, in particular erectile dysfunction.

Conclusion: Priapism is an unusual clinical manifestation of CML, whereas priapism is a urological emergency requiring immediate therapy. Treatment delay can cause complications of erectile dysfunction in men.  

References

Gogia A, Sharma A, Raina V, Gupta R. Priapism as an initial presentation of chronic lymphocytic leukemia. Leuk Lymphoma. 2012;53(8):1638-1639.

Mulhall JP, Honig SC. Priapism: etiology and management. Acad Emerg Med. 1996;3(8):810-816.

Stucki A, Rivier AS, Gikic M, Monai N, Schapira M, Spertini O. Endothelial cell activation by myeloblasts: molecular mechanisms of leukostasis and leukemic cell dissemination. Blood. 2001;97(7):2121-2129.

Frazer R, Irvine AE, McMullin MF. Chronic Myeloid Leukaemia in The 21st Century. Ulster Med J. 2007;76(1):8-17.

Höglund M, Sandin F, Simonsson B. Epidemiology of chronic myeloid leukaemia: an update. Ann Hematol. 2015;94 Suppl 2:S241-S247.

Rodgers R, Latif Z, Copland M. How I manage priapism in chronic myeloid leukaemia patients. Br J Haematol. 2012;158(2):155-164.

Adams BD, Baker R, Lopez JA, Spencer S. Myeloproliferative disorders and the hyperviscosity syndrome. Emerg Med Clin North Am. 2009;27(3):459-476.

Kang ZJ, Liu YF, Xu LZ, Long ZJ, Huang D, Yang Y, et al. The Philadelphia chromosome in leukemogenesis. Chin J Cancer. 2016;35:1-15.

Ghane N, Vard A, Talebi A, Nematollahy P. Classification of chronic myeloid leukemia cell subtypes based on microscopic image analysis. EXCLI J. 2019;18:382-404.

Hochhaus A, Saussele S, Rosti G, Mahon FX, Janssen JJWM, Hjorth-Hansen H, et al. Chronic myeloid leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv261.

Hoffmann VS, Baccarani M, Hasford J, Castagnetti F, Di Raimondo F, Casado LF, et al. Treatment and outcome of 2904 CML patients from the EUTOS population-based registry. Leukemia. 2017;31(3):593-601.

Steinberg MH. Sickle cell anemia, the first molecular disease: overview of molecular etiology, pathophysiology, and therapeutic approaches. Scientific World Journal. 2008;8:1295-1324.

Mc Aninch J. Disorders of the penis & male urethra. Smith's General Urology. 2008;1(1):1-10.

Jameel T, Mehmood K. Priapism An unusual presentation in chronic myeloid leukaemia: case report and review of the literature. Biomedica. 2008;25(2):197–199.

Chaux A, Amin M, Cubilla AL, Young RH. Metastatic tumors to the penis: a report of 17 cases and review of the literature. Int J Surg Pathol. 2011;19(5):597-606.

Muneer A, Ralph D. Guideline of guidelines: priapism. BJU Int. 2017;119(2):204-208.

Levey HR, Segal RL, Bivalacqua TJ. Management of priapism: an update for clinicians. Ther Adv Urol. 2014;6(6):230-244.


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