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Case Report

Veno-occlusive Priapism, An Undesirable Outcome of Warfarin Therapy: A Case Report

Author(s): Mohd Zulkimi Roslly*, Shameem Sulaiman and Anis Suhana Hashim

Volume 4, Issue 2, 2023

Published on: 18 July, 2023

Article ID: e260423216199 Pages: 5

DOI: 10.2174/0250688204666230426122302

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Abstract

Background: Priapism is one of the urological emergencies requiring prompt medical or surgical intervention. The clinical diagnosis is made with adjunct cavernosal blood gas analysis and colour doppler ultrasound to determine the underlying aetiology; ischaemic or non-ischaemic, and the majority are veno-occlusive in origin (ischaemic). The occurrence of warfarin-induced priapism complicated with penile necrosis is a rare occurrence, and many cases are related to protein C deficiency.

Case Presentation: We report a case of warfarin therapy initiation following a thromboembolic event as a sequela of COVID-19 infection, subsequently developed veno-occlusive priapism complicated with penile gangrene despite being in an overwarfarinized state. The penis was non-salvageable following the gangrenous event, even with prior cavernosal blood aspiration. Thrombophilia panel screening, which includes Protein C activity was done where the protein C activity was low, measuring 23%. Unfortunately, he succumbed to death due to severe cardiorespiratory complications before this blood result was ready.

Discussion: Prompt diagnosis and treatment of priapism is needed to prevent loss of penile function. Priapism as a sequela of anticoagulant therapy should be suspected in a patient with recent anticoagulant initiation. Thus, immediate treatment can be administered to correct the underlying coagulation disorder.

Conclusion: The development of veno-occlusive priapism and penile gangrene in a patient on warfarin therapy raises a concern about protein C deficiency.

[1]
Montague DK, Jarow J, Broderick GA, et al. American urological association guideline on the management of priapism. J Urol 2003; 170(4 Part 1): 1318-24.
[http://dx.doi.org/10.1097/01.ju.0000087608.07371.ca] [PMID: 14501756]
[2]
Carnicelli D, Akakpo W. Le priapisme : Diagnostic et prise en charge. Prog Urol 2018; 28(14): 772-6.
[http://dx.doi.org/10.1016/j.purol.2018.07.281] [PMID: 30201552]
[3]
Burnett AL. Pathophysiology of priapism: Dysregulatory erection physiology thesis. J Urol 2003; 170(1): 26-34.
[http://dx.doi.org/10.1097/01.ju.0000046303.22757.f2]
[4]
Salonia A, Eardley I, Giuliano F, et al. European Association of Urology guidelines on priapism. Eur Urol 2014; 65(2): 480-9.
[http://dx.doi.org/10.1016/j.eururo.2013.11.008] [PMID: 24314827]
[5]
Donaldson JF, Rees RW, Steinbrecher HA. Priapism in children: A comprehensive review and clinical guideline. J Pediatr Urol 2014; 10(1): 11-24.
[http://dx.doi.org/10.1016/j.jpurol.2013.07.024] [PMID: 24135215]
[6]
Sallah S, Thomas DP, Roberts HR. Warfarin and heparin-induced skin necrosis and the purple toe syndrome: Infrequent complications of anticoagulant treatment. Thromb Haemost 1997; 78(2): 785-90.
[http://dx.doi.org/10.1055/s-0038-1657628] [PMID: 9268171]
[7]
Daryanani S, Wilde JT. Priapism in a patient with protein C deficiency. Clin Lab Haematol 1997; 19(3): 213-4.
[http://dx.doi.org/10.1111/j.1365-2257.1997.tb00010.x] [PMID: 9352148]
[8]
Zimbelman J, Lefkowitz J, Schaeffer C, et al. Unusual complications of warfarin therapy: Skin necrosis and priapism. J Pediatr 2000; 137(2): 266-8.
[http://dx.doi.org/10.1067/mpd.2000.107159] [PMID: 10931425]
[9]
Barkley C, Badalament RA, Metz EN, Nesbitt J, Drago JR. Coumarin necrosis of the penis. J Urol 1989; 141(4): 946-8.
[http://dx.doi.org/10.1016/S0022-5347(17)41064-0] [PMID: 2648033]
[10]
Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, Shamloul R. Priapism: Pathogenesis, epidemiology, and management. J Sex Med 2010; 7(1): 476-500.
[http://dx.doi.org/10.1111/j.1743-6109.2009.01625.x] [PMID: 20092449]
[11]
Salerno TA, Charrette EJ, Morales A. Priapism after aortic valve replacement. Can J Surg 1981; 24(2): 202-3.
[PMID: 7225977]
[12]
Gyan E, Darre S, Jude B, et al. Acute priapism in a patient with unstable hemoglobin Perth and Factor V Leiden under effective oral anticoagulant therapy. Hematol J 2001; 2(3): 210-1.
[http://dx.doi.org/10.1038/sj.thj.6200104] [PMID: 11920248]
[13]
Andrieu V, Dumonceau O, Grange MJ. Priapism in a patient with unstable hemoglobin: Hemoglobin KAln. Am J Hematol 2003; 74(1): 73-4.
[http://dx.doi.org/10.1002/ajh.10374] [PMID: 12949895]
[14]
Verhagen H. Local haemorrhage and necrosis of the skin and underlying tissues, during anti-coagulant therapy with dicumarol or dicumacyl. Acta Med Scand 1954; 148(6): 453-68.
[http://dx.doi.org/10.1111/j.0954-6820.1954.tb01741.x] [PMID: 13171021]
[15]
Nagathan DS, Pahwa HS, Kumar A, Goel A. Anticoagulant-induced priapism progressing to penile gangrene: A devastating complication!. BMJ Case Rep 2012; 2012: bcr2012007073.
[http://dx.doi.org/10.1136/bcr-2012-007073]
[16]
Abu Shama RAH, Kufri FH, Yassin IH. Stuttering priapism complicating Warfarin therapy in a patient with protein C deficiency. Int J Lab Hematol 2008; 30(4): 339-43.
[http://dx.doi.org/10.1111/j.1751-553X.2007.00963.x] [PMID: 18665833]
[17]
Routledge PA, Shetty HGM, White JP, Collins P. Case studies in therapeutics: warfarin resistance and inefficacy in a man with recurrent thromboembolism, and anticoagulant-associated priapism. Br J Clin Pharmacol 1998; 46(4): 343-6.
[http://dx.doi.org/10.1046/j.1365-2125.1998.t01-1-00796.x] [PMID: 9803981]
[18]
Ericson C, Baird B, Broderick GA. Management of priapism. Urol Clin North Am 2021; 48(4): 565-76.
[http://dx.doi.org/10.1016/j.ucl.2021.07.003] [PMID: 34602176]
[19]
Reddy AG, Alzweri LM, Gabrielson AT, Leinwand G, Hellstrom WJG. Role of penile prosthesis in priapism: A review. World J Mens Health 2018; 36(1): 4-14.
[http://dx.doi.org/10.5534/wjmh.17040] [PMID: 29299902]
[20]
Muneer A, Cellek S, Dogan A, Kell PD, Ralph DJ, Minhas S. Investigation of cavernosal smooth muscle dysfunction in low flow priapism using an in vitro model. Int J Impot Res 2005; 17(1): 10-8.
[http://dx.doi.org/10.1038/sj.ijir.3901231] [PMID: 15071490]
[21]
Spycher MA, Hauri D. The ultrastructure of the erectile tissue in priapism. J Urol 1986; 135(1): 142-7.
[http://dx.doi.org/10.1016/S0022-5347(17)45549-2] [PMID: 3941454]

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