Priapismo
Priapismo
Priapismo
a r t i c l e i n f o a b s t r a c t
Article history: SARS-CoV-2 (COVID-19) infection is frequently associated with thromboembolic complications. In this case re-
Received 16 December 2020 port, we describe the diagnosis and management of priapism as a thromboembolic complication of severe
Accepted 26 December 2020 COVID-19.
Available online xxxx
Published by Elsevier Inc.
Keywords:
SARS-CoV2
COVID-19
Thromboembolism
Priapism
Please cite this article as: M.L. Silverman, S.J. VanDerVeer and T.J. Donnelly, Priapism in COVID-19: A thromboembolic complication, American
Journal of Emergency Medicine, https://doi.org/10.1016/j.ajem.2020.12.072
M.L. Silverman, S.J. VanDerVeer and T.J. Donnelly American Journal of Emergency Medicine xxx (xxxx) xxx
3. Discussion References
[1] Cases in the U.S.. CDC; 2020 Accessed August 2, 2020 https://www.cdc.gov/
Priapism is divided into three subtypes: ischemic (low-flow/veno-oc- coronavirus/2019-ncov/cases-updates/cases-in-us.html.
clusive), nonischemic (high-flow/arterial), and stuttering [8]. Resolution [2] Artifoni M, Danic G, Gautier G, et al. Systematic assessment of venous thromboem-
of ischemic priapism within 24 h is associated with better outcomes [9]. bolism in COVID-19 patients receiving thromboprophylaxis: incidence and role of
In conscious patients, pain typically differentiates ischemic from D-dimer as predictive factors. J Thromb Thrombolysis. 2020;50(1):211–6. https://
doi.org/10.1007/s11239-020-02146-z.
nonischemic priapism. However, in our sedated patient, we had to rely [3] Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombo-
on cavernosal ABG findings. ABG criteria suggestive of ischemia include sis in hospitalized patients with COVID-19 in a New York City health system. JAMA -
pO2 <30, pCO2 >60, and pH <7.25, all of which occurred in our patient. J Am Med Assoc. 2020. https://doi.org/10.1001/jama.2020.13372.
Case reports suggest that propofol can cause ischemic priapism in in- [4] Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients
with severe novel coronavirus pneumonia. J Thromb Haemost. 2020;18(6):1421–4.
dividuals undergoing procedures [10-12], including confirmation by re- https://doi.org/10.1111/jth.14830.
challenge with propofol [12]. However, our patient received propofol [5] Fa K, Kruip MJHA, van der Meer NJM. Incidence of thrombotic complications in crit-
for more than 12 h prior to pronation without issue or reoccurrence in ically ill ICU patients with COVID-19. Thromb Res. 2020;191:145–7.
subsequent weeks of propofol infusion. Additionally, the prevalence of [6] Lamamri M, Chebbi A, Mamane J, et al. Priapism in a patient with coronavirus dis-
ease 2019 (COVID-19): A case report. Am J Emerg Med. 2020. https://doi.org/10.
coagulopathy in COVID-19 and the associated risk of mortality requires 1016/j.ajem.2020.06.027.
greater attention to its likelihood as the precipitating factor. [7] Van der Horst C, Stuebinger H, Seif C, Melchior D, Martínez-Portillo FJ, Juenemann
Thromboembolic complications are frequent in COVID-19. In a study KP. Priapism - Etiology, pathophysiology and management. Int Braz J Urol. 2003;
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of 3334 patients in New York City, Bilaloglu et al. observed a 16% rate of
[8] Priapism Guideline - American Urological Association. Accessed August 2, 2020
thrombosis, 29.4% in ICU patients, using routine screening practices. https://www.auanet.org/guidelines/priapism-guideline; 2020.
Mortality in patients with thrombotic events was double that of those [9] Levey HR, Segal RL, Bivalacqua TJ. Management of priapism: an update for
without thrombosis (43.2% vs. 21.0%, p<0.001), including a multivari- clinicians. Ther Adv Urol. 2014;6(6):230–44. https://doi.org/10.1177/
1756287214542096.
able hazard ratio of 1.82 for VTE and 1.99 for arterial thromboembolism
[10] Fuentes EJ, Garcia S, Garrido M, Lorenzo C, Iglesias JM, Sola JE. Successful treatment
(ATE) [3]. In a smaller study of 150 COVID-19 patients, Helms et al. reported of propofol-induced priapism with distal glans to corporal cavernosal shunt. Urol-
an odds ratio of 2.6 (p<0.035) for thrombotic complications in COVID-19 ogy. 2009;74(1):113–5. https://doi.org/10.1016/j.urology.2008.12.066.
ARDS patients compared to those with non-COVID-19 ARDS [13]. [11] Senthilkumaran S, Shah S, Ganapathysubramanian Balamurgan N,
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Though the evidence has suggested an association between COVID-
42(4):238–9. https://doi.org/10.4103/0253-7613.68430.
19 and hypercoagulability, there is a lack of high-quality evidence [12] Vesta KS, D’Martina S, Kozlowski EA. Propofol-induced priapism, a case confirmed
supporting routine therapeutic anticoagulation. Consequently, the with rechallenge. Ann Pharmacother. 2006;40(5):980–2. https://doi.org/10.1345/
American Society of Hematology encourages participation in one of aph.1G555.
[13] Helms J, Tacquard C, Severac F, et al. High risk of thrombosis in patients with severe
“multiple randomized controlled trials” rather than empirically using
SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med.
anticoagulation with hospitalized patients with COVID-19 [14]. 2020;46(6):1089–98. https://doi.org/10.1007/s00134-020-06062-x.
[14] COVID-19 and VTE-Anticoagulation - Hematology.org. Accessed August 20, 2020
Declaration of Competing Interest https://www.hematology.org/covid-19/covid-19-and-vte-anticoagulation;
2020.
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