案例報告：陰莖海綿體膿瘍表現為陰莖異常勃起

張哲睿¹、莊梓昱^1,2、張彰琦¹、陳修聖¹

¹臺北市立聯合醫院外科部泌尿科; ²國立陽明交通大學醫學院醫學系泌尿部

Corpus cavernosum sterile abscess presented with priapism: a case report

Che-Jui Chang¹, Tzu-Yu Chuang^1,2, Chang-Chi Chang¹, Shiou-Sheng Chen¹

¹Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan

²Department of Urology, Faculty of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

Introduction

Corpus cavernosum abscess is a rare condition with an unknown cause. While many abscesses of the corpus cavernosum are idiopathic, there are various possible etiology, including untreated penile fracture, intracavernous therapy for erectile dysfunction, hematogenous spread after periodontal abscess, perianal or intracavitary abscess, and after drainage or surgical treatment of priapism.

The most common early clinical manifestations are penile edema, discomfort, and redness. Some cases presented with voiding symptoms and priapism. The most common causative organisms include Staphylococcus aureus, Streptococci, and Bacteroides. Diagnosis is typically made clinically and through imaging study (computed tomography [CT] and ultrasound). Here, we presented a case of corpus cavernosum sterile abscess presented with priapism.

Case presentation

A 61-year-old man with a history of end stage kidney disease under hemodialysis via arteriovenous shunt, tuberculosis peritonitis after peritoneal dialysis 1 years ago, congestive heart failure, chronic hepatitis C virus infection presented with persistent erection, genital swelling and pain for 2 days, accompanied with fever up to 39.8’C. On examination, the temperature was 39.8°C, the blood pressure 123/63 mm Hg, the pulse 142 beats per minute, and the oxygen saturation 95% while the patient was breathing ambient air. Physical examination showed persistent erection for more than 24 hours with tenderness. Laboratory data showed leukocytosis (WBC:24950/UL, Neut:81.4%), chronic anemia (Hb:7.8g/dl), BUN:42.2mg/dL, Cr:6.0mg/dL, and elevated CRP (325.8mg/L). Penile sonography suspected penile abscess accumulations with increased blood flow (Figure 1). Empirical antibiotic with Cefepime was given. We performed drainage of penile shaft and much abscess was drained out (Figure 2). Aerobic, anaerobic culture, and acid-fast stain of the abscess showed negative for bacteria and tuberculosis. Klebsiella pneumoniae ssp pneumoniae was noted in the blood culture. Pelvic CT revealed abscess formation at corpus cavernosa of penis and loculated intra-abdominal fluid accumulation at right pelvic cavity (Figure 3). Due to poor wound healing, we kept wound wet dressing with normal saline. Under the stable condition, he was discharged after wound healing. There was no recurrent abscess formation during outpatient department follow-up.

Conclusion

Corpus cavernosum abscess can presented with priapism. Culture of the abscess may be sterile. Simple incision and drainage in conjunction with intravenous antibiotic therapy could be successful resolution of the abscess without long-term sequela.