Pediatr Urol Case Rep 2021; 8(4):83-85 DOI: 10.14534/j-pucr.2021267555 ABSTRACT A case of spontaneous priapism in a ten year old child with acuta lymphoblastic leukaemia is presented. Emergent management options like drainage, sympathomimetic agents, and medical treatment to reduce circulating white cell counts and shunt surgery are discussed. Key Words: Paediatric priapism, acute lymphoblastic leukaemia, priapism drainage Acute lymphoblastic leukaemia presenting as paediatric priapism Prashant Motiram Mulawkar*, Sumit Gopal Agrawal, Narendra Bhikulal Rathi, Gaurav Shivprakash Mantri, Deepak R Bhat, Ashwin Mapari Department of Urology, Tirthankar Superspeciality Hospital, Gaddam Plots, Akola, Maharashtra, India Prashant Motiram Mulawkar Department of Urology, Tirthankar Superspeciality Hospital, Maharashtra, India, E-mail: pmulawkar@hotmail.com Received: 2021-06-14 / Accepted: 2021-06-28 Publication Date: 2021-07-05 Introduction Priapism is a penile erection which lasts for more than four hours. It occurs in the absence of sexual stimulation. It is a urological emergency. Prolonged priapism has the risk of penile fbrosis leading to erectile insufciency. Priapism is rare in children. Sickle cell disease is the common cause of priapism in children. Leukaemia is an uncommon cause of priapism in paediatric age group [1]. Case report Ten year old male child presented with persistent painful erection for last 24 hours (Fig 1). He had one episode of vomiting, dribbling of urine and difculty in urination, fever. There was no history of trauma to penis, penile manipulation, haematuria or pain in abdomen. He had no known medical disorder. On Examination he had hepatosplenomegaly. There was no free fuid in abdomen. Penile examination revealed both corpora to be turgid tender. The glans was not turgid. Both testes were normal. Laboratory investigations revealed haemoglobin: 10.2; total Leukocyte count: 289000; platelet count: 62000. On peripheral smear the blasts were 90%. His coagulation parameters were deranged; INR: 2.07; APTT Control: 26; patient: 42 LDH-2107. With these fndings a diagnosis of ischaemic priapism due to haematological malignancy was kept. Paediatrician and medical oncology opinion was sought. They advised bone marrow aspiration. His bone marrow aspirate was sent. Priapism was managed on emergent basis. Patient was taken for corporal aspiration with 22G scalp vein. Initially dark red colour blood about 50 cc was drained which gradually turned to bright red colour with detumescence of penis. But soon after removal of scalp vein priapism reappeared. Patient was shifted to intensive care unit for monitoring. He was treated with intravenous fuids, antibiotics and oral ibuprofen. Fig. 1. Clinical photograph showing erect penis.