108 Published by Bali Medical Journal | Bali Medical Journal 2021; 10(1): 108-110 | doi: 10.15562/bmj.v10i1.2125 CASE REPORT ABSTRACT Penile gangrene as a priapism sequele due to Chronic Myeloid Leukemia (CML): the frst report in Indonesia Deddy Rasyidan Yulizar 1 , Eka Putri Maulani 2* , Heru Prasetya 3 , Hendra Sutapa 3 , Eka Yudha Rahman 3 Background: Priapism is defned as a prolonged erection of the penis lasting over 6 hours in the absence of sexual stimulation. Priapism is divided into two types, Low-Flow (ischemic priapism) and High-Flow (trauma). This case study aims to evaluate penile gangrene as a priapism sequele due to Chronic Myeloid Leukemia (CML) as the frst report in Indonesia. Case Presentation: A 45-years old male patient admitted at Muara Teweh hospital before referred to Ulin Hospital presented with Fournier gangrene with unconfrmed leukemia as comorbidities used in this case report. In his medical history, “Snake Maneuver Shunting” has been carried out in this patient as an indication for priapism lasting more than 24 hours. Conclusion: Hyperleukocytosis is thought to be the cause of priapism in patients with leukemia. Leukostasis is the most common medical emergency seen on CML patients in blast crisis. Keywords: Priapism, CML, Fournier Gangrene, Penile Gangrene. Cite This Article: Yulizar, D.R., Maulani, E.P., Prasetya, H., Sutapa, H., Rahman, E.Y. 2021. Penile gangrene as a priapism sequele due to Chronic Myeloid Leukemia (CML): the frst report in Indonesia. Bali Medical Journal 10(1): 108-110. DOI: 10.15562/bmj.v10i1.2125 1 Urology Division, Surgery Department, Faculty of Medicine, Universitas Lambung Mangkurat, Ulin General Hospital, Banjarmasin, Indonesia 2 Resident of The Surgery Department, Faculty of Medicine, Universitas Lambung Mangkurat, Ulin General Hospital, Banjarmasin, Indonesia 3 Urology Division, Surgery Department, Faculty of Medicine, Universitas Lambung Mangkurat, Ulin General Hospital, Banjarmasin, Indonesia *Corresponding author: Eka Putri Maulani; Resident of The Surgery Department, Faculty of Medicine, Universitas Lambung Mangkurat, Ulin General Hospital, Banjarmasin, Indonesia; ekaputrimaulani15@gmail.com Received: 2020-12-09 Accepted: 2021-03-16 Published: 2021-04-01 108 Published by Bali Medical Journal Bali Medical Journal (Bali MedJ) 2021, Volume 10, Number 1: 108-110 P-ISSN.2089-1180, E-ISSN: 2302-2914 Open access: www.balimedicaljournal.org INTRODUCTION Priapism is defned as a prolonged erection of the penis lasting over 6 hours in the absence of sexual stimulation. 1 It is a potentially painful condition in which the erect penis does not return to its faccid state, despite the absence of both physical and psychological stimulation. 1 It is a medical emergency and for its function to return, early treatment is essential. Priapism is divided into two types, Low- Flow (ischemic priapism) and High- Flow (trauma). Ischemic priapism is a surgical emergency that requires urgent intervention. 1,2 Priapism etiology ranges from idiopathic, pharmacological, hematologic disorder (sickle cell disease, leukemias, penile metastases, etc.) or particular neurological disorder. 3 Te sequele of priapism, if not treated appropriately, can either become permanent erectile dysfunction or, rarely, penile gangrene. 4 Penile gangrene associated with priapism has been reported in patients with sickle cell disease, urethral cancer, thrombotic thrombocytopenic purpura, bladder carcinoma. 3-5 Based on those mentioned above, this case study aims to present a chronic myeloid leukemia patient presented with ischemic priapism, penile gangrene, and Fournier’s gangrene. CASE REPORT A 45 years old male patient admitted at Muara Teweh hospital before referred to Ulin Hospital presented with Fournier gangrene with unconfrmed leukemia as comorbidities. In his medical history, “Snake Maneuver Shunting” has been carried out in this patient as an indication of priapism that lasts more than 24 hours. Two days afer the treatment, Fournier gangrene occurred, and the patient was immediately referred to Ulin Hospital. Te patient presented with a complaint of the darkened penis shaf and both sides of the scrotum accompanied by pain (Figure 1). A shunt connecting the right and lef corpus cavernosum is attached to the patient’s glans penis. Clinically, the patient showed signs of sepsis and based on a laboratory test, and his leukocytes are 241,500 mg/dL. A debridement-necrotomy that exposes scrotum to tunica vaginalis and penis shaf to tunica dartos has been done (Figure 2). Afer degloving the penile shaf, the glans appeared to be blackened, and Figure 1. Anterior Aspect Clinical Picture in Emergency Room (ER)