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October 11, 1993

Priapism in Sickle Cell Disease: Possible Contributory Effect of Cocaine Use

Arch Intern Med. 1993;153(19):2287. doi:10.1001/archinte.1993.00410190133017

A 26-year-old black man with sickle cell disease (hemoglobin SS) was admitted for severe priapism of 1-day duration. He had a history of a prior episode 3 years ago that was treated successfully with intravenous hydration, analgesia, and packed red blood cell transfusion, with no subsequent sexual dysfunction. On admission, physical examination revealed conjunctival pallor and engorgement of both corpora cavernosa with an extremely enlarged tender penis. Before onset of erection, the patient admitted intranasal use of cocaine, which he started using recently during the last 2 months prior to admission. Abnormal results of laboratory studies included a hematocrit of 25%; reticulocyte count of 9%, and the presence of sickle cells in the peripheral blood smear. Urine drug screening revealed negative results except for cocaine. Minimal improvement was observed after intravenous hydration, analgesia, packed red blood cell transfusion, and stilbestrol at 5 mg daily for 4 days.1 On the