Case report: An unusual case of priapism.

A 6 year old boy presented with a 12 hour history of painful erection of the penis. This started spontaneously and had been preceded by a one day history of fever which was ongoing. He was able to urinate but with difficulty. There was no previous history of priapism or episodes of limb or joint pain. He had never been admitted to hospital before and had never had a blood transfusion. He was not taking any medications and his immunisations were up-to-date. On examination he looked well grown for his age but was in obvious pain. There were no signs of jaundice or anaemia. He had a fever of 38.50C and heart rate of 130bpm. He had an erect swollen penis which was painful to examine. The rest of the examination was unremarkable. A malaria parasite screen and sickle solubility test were both negative. Intravenous chloramphenicol and gentamicin were started together with intravenous fluids and morphine. A surgical consultation was requested but shortly after admission his priapism began to resolve and surgical intervention was not indicated. As he appeared to be improving intravenous fluids were discontinued. However on the second day of admission, his mother reported that his behaviour was abnormal. In particular he would get very agitated whenever he was made to drink fluids and was noted to choke and have involuntary spasms of his head and neck. He remained febrile with fevers up to 39.5oC and so antibiotics were changed to ceftriaxone. Over the next 12 hours he became progressively more agitated with fluctuating periods of confusion where he did not recognise his mother and was aggressive towards her. He was also noted to have excessive salivation and was unable to swallow anything. He was restarted on intravenous fluids and also on a diazepam infusion but a few hours later his conscious level deteriorated and shortly after this he died.