A 62-year-old patient testing positive for SARS-CoV-2 experienced priapism—a persistent, painful erection—prompting doctors to explore a potential Covid-19 link.
The patient initially sought care for fever, dry cough, and diarrhea. Suspecting a bacterial infection, his GP prescribed clarithromycin. Two days later, severe acute respiratory distress led to hospitalization in Versailles, France, where he required mechanical ventilation.
Rapid testing confirmed Covid-19. During evaluation, clinicians discovered priapism, defined as a painful erection lasting over four hours without physical or psychological stimulation.
Priapism occurs when blood fills the corpora cavernosa but fails to drain, risking permanent penile damage and erectile dysfunction if untreated. Prompt intervention is critical.
To resolve it, the medical team applied ice packs for compression and aspirated trapped blood, revealing dark clots indicative of low-flow (ischemic) priapism due to venous outflow obstruction. Unlike high-flow priapism from arterial issues, this form stems from blocked venous drainage. The patient recovered and was discharged soon after.
Covid-19 can trigger hypercoagulability, leading to thromboembolic events like deep vein thrombosis and pulmonary embolism—affecting about one-third of ICU patients and necessitating anticoagulation therapy.
While ischemic stroke and acute coronary syndrome occur less often, penile thrombosis had not been previously documented in Covid-19 cases.
Reporting in The American Journal of Emergency Medicine, the physicians suggest a plausible link, as Covid-19 promotes thrombosis through hyperviscosity, hypofibrinolysis, and endothelial dysfunction.
"While evidence supports a causal relationship between Covid-19 and ischemic priapism in this case, additional reports would bolster confirmation," the researchers conclude.
