38-Year-Old Man With Priapism and a History of Paranoid Schizophrenia

Abstract

38-year-old man with a 20-year history of paranoid schizophrenia presented to the hospital with a prolonged, painful erection of the penis (priapism) occurring for 48 hours. The patient denied previous events of priapism, substance abuse, genital trauma, erectile dysfunction, or history of a prior hypercoagulable state. Physical examination revealed engorgement of both the corpora cavernosa and the corpus spongiosa but no evidence of genital trauma. The patient had a history of psychotic symptoms. During the first 10 years of treatment, the patient had been given various traditional neuroleptics such as trifluoperazine, haloperidol, thiothixene, and fluphenazine. However, his psychotic symptoms continued to be poorly controlled. The patient was hospitalized numerous times for paranoia and auditory and visual hallucinations; a trial of clozapine was initiated, with considerable improvement in the patient’s symptoms. Clozapine and phenytoin therapy was continued for at least 8 years until the occurrence of priapism. Results of the patient’s physical examination were otherwise normal. His only medications at the time were clozapine, 800 mg at bedtime and 100 mg every morning, and phenytoin, 200 mg orally per day.