Stuttering Priapism in a Patient with Neurosyphilis
A 41-year-old male patient with no significant past medical history visited our hospital due to a painful erection that lasted for 6 hours. He had also been seen in the emergency department of another hospital 5 days prior with the same condition. On both occasions, he was treated by aspirating blood from the corpus cavernosum followed by conservative management. The patient was subsequently discharged after detumescence. In our hospital, the patient's vital signs were within normal limits, and physical examination revealed an erection with 90~100% rigidity.\nA complete blood count was unremarkable, with a hemoglobin of 17.1 g/dl, red blood cell count of 5,240 k/ul, white blood cell count of 9,900/ul, and platelet count of 246 k/ul. Liver function tests indicated elevated aspartate aminotransferase (82 IU/L), alanine aminotransferase (110 IU/L), and alkaline phosphatase (189 IU/L). Erythrocyte sedimentation rate and C-reactive protein were also increased at 44 mm/h and 24.39 mg/L, respectively. Chemical tests, blood clotting tests, and urinalysis were within normal limits. A corporal blood gas test suggested ischemic priapism, with a pH=6.9, pCO2=146.5 mmHg, and pO2=37 mmHg. Testing for sexually transmitted infections revealed a venereal disease researchlaboratory (VDRL) titer of 1:128, rapid pasma reagin=2.5, and treponema pallidum hemagglutination test titer of 1:2,560 suggesting reactive syphilis. Other tests including Chlamydia and human immunodeficiency virus antibody tests were negative. Color Doppler sonography was not performed due to the irritable state of the patient.\nThe patient was treated with intramuscular benzathine penicillin G (2,400 kIU) 3 times at intervals of one week. Aspiration of blood from the corpus cavernosum resulted in detumescence, but priapism recurred on 3 occasions over a 4 weeks period. Although intracavernous injection of sympathomimetic drugs was performed, the condition of the patient did not improve. We chose to initiate surgical intervention using a cavernoso-glandular shunt, which was performed using a 1 cm incision along the glans (). Post-operatively, complete detumescence was achieved. Since the VDRL titer dropped to 1:64, the titer remained unchanged despite of penicillin treatment. Therefore, we performed a cerebrospinal fluid (CSF) examination to exclude neurosyphilis. On analysis of CSF during hospitalization, the VDRL titer was increased at 1:4. The patient refused further treatment or evaluation and was discharged. The patient died of pancreatic cancer at another hospital several months later.