Priapism: A rare presentation of precursor B-Cell acute lymphoblastic leukemia

摘要

A previously healthy 9-year-old boy was admitted to our emergency service with painful erection for the last 18 hours. He had no previous trauma, drug usage or blood disease. Physical examination was unremarkable apart from priapism. Laboratory tests revealed a very high white blood cell (WBC) count (583xlOVL), hemoglobin 9.3 g/ dL, platelet count 51 xlO9/L, increased lactate dehydrogenase level (3493 U/L), and prolonged prothrombin time and activated thromboplastin time (16.5 and 30.3 sec, respectively). Ninety percent of the cells on peripheral blood smear were LI type lymphoblasts. Puncture of the corpus cavernosum of the penis provided temporary improvement and together with immediate intravenous hydration, hydroxyurea, allopurinol, and leukapheresis, WBC count decreased to 340 xlOVL and priapism resolved. Flow cytometric analysis of bone marrow confirmed the diagnosis of precursor B -ALL and ALL IC-BFM 2009 protocol was started. No further episode of priapism was seen and remission was ensued.