Veno-occlusive Priapism: An Undesirable Outcome of Warfarin Therapy: A Case Report

Priapism is one of the urological emergencies requiring prompt medical or surgical intervention. The clinical diagnosis is made with adjunct cavernosal blood gas analysis and colour doppler ultrasound to determine the underlying aetiology; ischaemic or non-ischaemic, and the majority are veno-occlusive in origin (ischaemic). The occurrence of warfarin-induced priapism complicated with penile necrosis is a rare occurrence, and many cases are related to protein C deficiency. We report a case of warfarin therapy initiation following a thromboembolic event as a sequela of Covid-19 infection, subsequently developed veno-occlusive priapism complicated with penile gangrene despite being in an overwarfarinized state. The penis was non-salvageable following the gangrenous event, even with prior cavernosal blood aspiration. Thrombophilia panel screening, which includes Protein C activity, was done, where the protein C activity was low, measuring 23%. Unfortunately, he succumbed to death due to severe cardiorespiratory complications before this blood result was ready. Prompt diagnosis and treatment of priapism is needed to prevent loss of penile function. Priapism as a sequela of anticoagulant therapy should be suspected in a patient with recent anticoagulant initiation. Thus, immediate treatment can be administered to correct the underlying coagulation disorder. The development of veno-occlusive priapism and penile gangrene in a patient on warfarin therapy raises a concern about protein C deficiency.