LAUSR

TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: COVID-19 is thought to cause a prothrombotic state with a relatively high rate of associated thromboembolic disease. Priapism has previously been described in a single case report as a potential thrombotic complication of severe COVID-19.1 Priapism, the persistence of an erection not associated with sexual desire, mostly commonly results from ischemic (low-flow or veno-occlusive) causes. Medications and blood dyscrasias are among the most common etiologies of ischemic priapism. Here we report a case of priapism in a patient admitted to the medical ICU for ARDS caused by severe COVID-19. CASE PRESENTATION: A 68-year-old man with a past medical history of chronic kidney disease, benign prostatic hyperplasia, and diabetes mellitus presented to the emergency department for worsening dyspnea, nausea and fatigue. He had been diagnosed with COVID-19 eight days prior. On arrival, the patient was profoundly hypoxemic despite being placed on high-flow nasal cannula. He was then intubated and placed on mechanical ventilation. A chest x-ray showed bilateral patchy infiltrates consistent with COVID-19 pneumonia. The patient became hypotensive and was started on vasopressors. His platelet count was normal and he was maintained on heparin subcutaneously three times per day for DVT prophylaxis. On the morning of hospital day seven, it was noted that the patient had a persistent erection for > 4 hours. He had not received any alpha adrenergic antagonist, antipsychotic, or antidepressant medications.Urology was consulted who subsequently performed a corporal aspiration and irrigation. Approximately 75 cc of dark blood were evacuated, which led to flaccidity of the penis. A corporal blood gas was found to be consistent with ischemia with a pH<6.8, pCO2=86, and a paO2=19. Over the next three days, the patient required three additional aspiration and irrigation procedures due to recurrent priapism, and each time dark blood was drained. A combination of intracavernosal injection of phenylephrine and aspiration on hospital day 10 led to resolution of his priapism. Despite maximal medical management, the patient developed multiorgan failure and expired after a prolonged hospital course. DISCUSSION: This case is the second reported case of priapism in a patient admitted to a medical ICU for severe COVID-19. The patient's priapism was thought to be as a result of a prothrombotic state related to COVID-19. At the time of the diagnosis, the patient had not received any medications associated with priapism and was not on a propofol infusion. Per the patient's partner, he had no known prior episodes of priapism. CONCLUSIONS: Priapism may be a rare thromboembolic complication of severe COVID-19. Prompt recognition of this condition is important as a delay in diagnosis can lead to irreversible penile damage and erectile dysfunction. REFERENCE #1: Lamamri M, Chebbi A, Mamane J et al. Priapism in a patient with coronavirus disease 2019 (COVID-19). Am J Emerg Med. 2021. 39: 251. e5-251 DISCLOSURES: No relevant relationships by Karl Andersen, source=Web Response No relevant relationships by Brandon Childs, source=Web Response No relevant relationships by James Dargin, source=Web Response