Priapism and Penile Gangrene Due to Thrombotic Thrombocytopenic Purpura

A 51-year-old man presented with 4 days of idiopathic ischemic priapism. Partial detumescence was achieved with aspiration and injection with intracorporeal adrenaline. On further evaluation, the patient was diagnosed with thrombotic thrombocytopenic purpura. This was treated with plasma exchange and steroids.

The penis was initially observed for 3 weeks, which subsequently became necrotic and infected, requiring debridement. After debridement of penile shaft skin, it became apparent that the entire penis was necrotic, necessitating total penectomy. The wound was closed secondarily 2 weeks later.

Gangrene of the penis after priapism is very rare. Priapism associated with thrombotic thrombocytopenic purpura has not been reported previously in published data.