SHM Converge Scientific Abstract ePoster Gallery-Ischemic Priapism: A Complication of Severe Covid-19 Infection

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This case describes a 41-year-old unvaccinated man with hypogonadism who developed severe COVID-19 pneumonia and later ischemic priapism. He presented 11 days after COVID diagnosis with progressive shortness of breath, marked hypoxia (SpO2 47%), tachypnea, and severe respiratory acidosis. Chest X-ray showed diffuse interstitial and alveolar airspace disease consistent with COVID pneumonia. He improved initially with BiPAP, IV dexamethasone, sarilumab, and enoxaparin prophylaxis.<br /><br />Eight hours after admission, he developed a painful erection that had been present for five hours. Urology found a firm, tender penile shaft and cold, tender glans, consistent with low-flow priapism. Corporal blood gas showed severe ischemic changes (pH 6.82, pO2 40, pCO2 110). Aspiration of dark blood from the corpora followed by phenylephrine produced temporary detumescence, but priapism recurred within four hours and again after a repeat aspiration. An Al-Ghorab shunt was being planned when his respiratory status worsened, requiring intubation. About 24 hours after admission, he suffered pulseless electrical activity cardiac arrest and could not be resuscitated.<br /><br />The report highlights that priapism is a rare complication of severe COVID-19, with fewer than 10 reported cases in the literature. The proposed mechanism is a COVID-related prothrombotic and inflammatory state causing endothelial dysfunction and impaired venous drainage from the corpora cavernosa. High inflammatory markers such as CRP and procalcitonin may support this association. The authors emphasize the need for high clinical suspicion because ischemic priapism is a urologic emergency requiring prompt treatment to prevent permanent erectile dysfunction and infertility.

Asset Subtitle

Sourabh Khatri

Meta Tag

Author List Shalini Khatri, Sourabh Khatri, Vikas Singh

Category Clinical Vignettes

Concept COVID-19 Pneumonia

Concept Ischemic Priapism

Concept Hypoxia

Concept Corporal Blood Gas

Concept Painful Rigid Penis

Distinguished Non-Finalist

Presenter Organization UPMC- McKeesport

Presenting Author Sourabh Khatri

Track Adult

Keywords

COVID-19 pneumonia

ischemic priapism

hypogonadism

severe hypoxia

corporal blood gas

phenylephrine

Al-Ghorab shunt

prothrombotic state

endothelial dysfunction

urologic emergency

COVID-19 Pneumonia

Ischemic Priapism

Hypoxia

Corporal Blood Gas

Painful Rigid Penis