Case 3: Priapism in a 13-year-old Boy

Amanda J. Clark; Peter Hsu; Anne Darves-Bornoz; Stacy T. Tanaka; Emily F. Mason; Howard M. Katzenstein

doi:10.1542/pir.2017-0051

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Amanda J. Clark, MD*
Peter Hsu, MD, MS^†
Anne Darves-Bornoz, MD^‡
Stacy T. Tanaka, MD, MS^§
Emily F. Mason, MD, PhD^¶
Howard M. Katzenstein, MD^†

^*Department of Pediatrics,
^†Division of Pediatric Hematology and Oncology, Department of Pediatrics,
^‡Department of Urology,
^§Division of Pediatric Urology, Department of Urology, and
^¶Division of Hematopathology, Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN

AUTHOR DISCLOSURE
Drs Clark, Hsu, Darves-Bornoz, Tanaka, Mason, and Katzenstein have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 13-year-old boy without a significant medical history presents with a painful erection that has persisted for 3 days. He denies any known stimulus, trauma, or new medications. He has not had any other symptoms except for vague headaches and leg pain in the past month. He has seen 2 providers in the past 3 days, who prescribed therapies including lidocaine, oral pseudoephedrine, and antibiotics without relief. No laboratory tests were obtained at either visit.

On physical examination he is afebrile, his blood pressure is 146/76 mm Hg, and his heart rate is 117 beats/min. He appears uncomfortable from penile pain but is nontoxic. On abdominal examination, his spleen is palpable 4 cm below the costal margin, and his genitourinary examination reveals an erect penis that is erythematous, tender to palpation, and without any obvious perfusion defects. The remainder of his examination findings are normal.

Pediatric urology is urgently consulted for management of priapism, and laboratory studies are sent, which reveal the etiology of his symptoms.