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Priapism Associated With Antipsychotic Medication Use: Case Report.

Copyright inpatient psychiatric unit for bizarre behavior, disorganized speech, and paranoid delusions. Mr A. was observed talking to unseen people and suspiciously looking around his environment. He refused to answer most questions. Further history was obtained from family, who reported that Mr A.’s behavior began 9 months prior to admission when he stopped taking his medications. Mr A. was throwing eggs and household objects at family members. He was talking to himself and recently began displaying threatening behavior such as swinging a bat at family members. Mr A. received a diagnosis of schizophrenia at the age of 12 years and had been hospitalized multiple times, but he could not provide details of prior hospitalizations. He reported being on an unspecified longacting injectable antipsychotic medication over 1 year prior to admission and more recently on oral fluphenazine, which he had been noncompliant with. He had a history of priapism with trazodone use in the past, but was unaware of the length or frequency of priapism episode. There was no known history of priapism with any other medications. Medical history was notable for hypertension, a remote history of gunshot wound to the abdomen status post surgical repair and trauma 1 year ago to the scrotum with resulting hydrocele and epididymitis. He denied lasting impairment from the scrotal injury. He did not have a history of blood transfusions, blood clots, bleeding issues, or cancer. MrA.’s urine drug screen was positive for both cocaine and benzodiazepines, although he adamantly denied use of illicit drugs or alcohol at the time of presentation. On admission, Mr A. was started on fluphenazine 2 mg orally (po) twice a day (BID) for psychosis and clonazepam 1 mg PO 3 times daily for behavioral control. Fluphenazine was started as Mr A. had been prescribed it in the prior year and was unwilling to take any other antipsychotic medications. On hospital day 7, Mr A. complained of painful penile erection unrelated to sexual stimulation. The duration of erection was unclear as Mr A. was too disorganized to provide details. Hewas treated successfully in the emergency department with a phenylephrine injection in the corpus cavernosum. Laboratory tests including complete blood count and basic metabolic panel were within normal limits. The consulting urologist gave Mr A. a diagnosis of priapism of unknown etiology. Fluphenazine was immediately discontinued because priapism is a known, but rare, adverse effect of fluphenazine. Because olanzapine has a relatively low affinity for the α receptor and therefore is hypothesized to be less likely to cause