Case report of a sickle cell disease patient with priapism triggered by Anti-Convulsant Therapy in Juth

Abstract

Background: Priapism is defined as an abnormal persistent erection of the penis. It is usually painful and it is unrelated to sexual stimulation or unrelieved by ejaculation. Priapism results from a variety of possible etiological factors, including a number of pharmacological agents like anti epileptic medications.

Case summary: A 30-year-old man, a known sickle cell disease patient with background post cerebrovascular accident (CVA) seizure disorder, developed multiple episodes of priapism after commencement of a particular antiepileptic medication. The onset of priapism was noticed to coincide with the commencement of levetiracetam, an antiepileptic drug, and persisted while patient was on the medication. He had several conservative and surgical interventions for the twelve episodes of priapism he  had over the two-year period  following commencement of levetiracetam. These included corporal aspiration, Winter’s, T, Ebbehoj distal shunts with the last  intervention being Al-Ghorab  shunt. The withdrawal of the anticonvulsant, levetiracetam, however coincided with the cessation of  priapism. He was subsequently commenced on Tab Epilin Chromo 200 mg bd, Meditriol 0.25  mgdly, and Neurovite forte 1 dly. He also  became seizure free subsequently.

Conclusion: A possible causative factor of priapism in this patient, namely levetiracetam, could  have  been masked by the background hemoglobinopathy but for a high index of suspicion. The  withdrawal of this anticonvulsant coincided  with the resolution of priapism in this patient.