Priapism: a rare presentation of precursor b-cell acute lymphoblastic leukemia

摘要

A previously healthy 9-year-old boy wasadmitted to our emergency service withpainful erection for the last 18 hours. Hehad no previous trauma, drug usage orblood disease. Physical examination wasunremarkable apart from priapism. Laboratorytests revealed a very high white blood cell(WBC) count (583x109/L), hemoglobin 9.3 g/dL, platelet count 51 x109/L, increased lactatedehydrogenase level (3493 U/L), and prolongedprothrombin time and activated thromboplastintime (16.5 and 30.3 sec, respectively). Ninetypercent of the cells on peripheral blood smearwere L1 type lymphoblasts. Puncture of thecorpus cavernosum of the penis providedtemporary improvement and together withimmediate intravenous hydration, hydroxyurea,allopurinol, and leukapheresis, WBC countdecreased to 340 x109/L and priapism resolved.Flow cytometric analysis of bone marrowconfirmed the diagnosis of precursor B -ALLand ALL IC-BFM 2009 protocol was started.No further episode of priapism was seen andremission was ensued.