ISSN 2997-1036
International Journal of Hematology | Vol. 2, No. 5, May 2011 | pp. 33–40
DOI: 10.46882/2011/IJH/000017
Case Report
Title: Priapism as the Initial Presentation of Hyperleukocytic Acute Myeloid Leukemia: Successful Management with Leukapheresis
Names of Authors: N. R. Danjuma¹, O. B. Nwosu², P. C. Okechukwu³
Authors’ Affiliations: ¹Department of Haematology, Ahmadu Bello University, Zaria, Nigeria; ²Department of Surgery and Urology, University of Nigeria, Nsukka, Nigeria; ³Department of Internal Medicine, Enugu State University of Science and Technology, Enugu, Nigeria
Abstract: Hyperleukocytosis in acute leukemia is a medical emergency that can cause leukostasis, vascular occlusion, and tissue ischemia. We report a unique case of an 24-year-old male who presented with an unprovoked, painful erection lasting 36 hours. A complete blood count revealed a total white blood cell count of 284 × 10⁹/L, with 88% circulating myeloblasts, confirming acute myeloid leukemia (M2 subtype). Peripheral blood smear examination and bone marrow biopsy supported the diagnosis. Hydroxyurea therapy (4 g daily) and aggressive intravenous hydration were initiated immediately. Due to persistent priapism and neurological alterations, a therapeutic leukapheresis procedure was performed, successfully reducing the white blood cell count to 92 × 10⁹/L within 6 hours. Complete detumescence was achieved post-leukapheresis without requiring surgical cavernous shunting. Subsequent standard cytarabine and daunorubicin induction therapy led to complete hematological remission. This case emphasizes hyperleukocytosis as a rare cause of ischemic priapism and demonstrates that prompt leukapheresis is critical for preventing permanent erectile dysfunction and leukostasic complications.
Keywords: Acute myeloid leukemia, hyperleukocytosis, priapism, leukapheresis, leukostasis
Manuscript Timeline: Received: February 15, 2011; Revised: March 24, 2011; Accepted: April 10, 2011; Published: May 16, 2011