2020-07-03

The first report of a patient with new coronary pneumonia presents with an abnormally long penile erection

By ddzyx

Recently, the American Journal of Emergency Medicine published a case report of a new coronary pneumonia patient from France. But unlike other reports focusing on the patient’s respiratory system, medical staff in France found that this new coronary pneumonia patient had a complication related to male reproductive organs.

Nearly 5%of COVID-19 patients require intensive care (ICU), with clinical manifestations of acute respiratory distress syndromeMainly. In addition to life-threatening respiratory distress, other potentially fatal complications include hypercoagulability. The incidence of thromboembolic complications in ICU patients is as high as 31%. Focal thrombosis and hyperviscosity may be related to abnormal penile erection, but there have been no reports of penile thrombosis in patients with COVID-19 . A case of COVID-19 with an abnormal penile erection was first reported in the American Journal of Emergency Medicine by the University of Paris-Saclay, Paris Saint-Joseph Hospital and Versailles Hospital.

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The patient is a 62-year-old male with left groin surgery and appendix History of resection, manifested as fatigue, fever, dry cough, diarrhea. Initially suspected to be a bacterial infection, the patient’s general practitioner gave clarithromycin. Two days later, the patient developed acute dyspnea. When the mobile emergency medical team arrived, the patient developed respiratory failure and received etomidate and succinylcholine for rapid sequential induction combined with midazolam and sufentanil for sedation. Intubation and mechanical ventilation. Subsequently, the patient developed hemodynamic disorders on the spot and received intravenous fluid resuscitation and 0.1 μg/Kg/min norepinephrine. Before entering the ICU, the patient’s chest CT and CT angiography showed diffuse lung parenchyma, which was ground glass-like, the leaflet interval thickened to form a lithotripsy sign, and no signs of proximal pulmonary embolism were found.

After the ICU arrived, the patient’s blood pressure was 116/82mmHg, heart rate was 100 beats/min, and body temperature was 38.5℃. The patient developed severe acute respiratory distress syndrome with an oxygenation index of 66. Physical examination revealed a previously unknown penile erection, which showed stiff cavernous bodies and loose gui heads. Bronchial aspirate nucleic acid detection confirmed that the patient was infected with SARS-CoV-2.

After cold compressing with an ice pack for 4 hours, the symptoms did not improve, the medical staff used a needle to draw out the blood of the reproductive organs of the case, and found that there were dark-colored blood clots, which were thought to be caused by these blood clots. The man had an abnormal erection of”low flow type”. This hypothesis was confirmed by corpus cavernosum blood gas analysis, showing acidosis (pH 6.98), carbon dioxide partial pressure of 121 mmHg, and oxygen partial pressure of 68 mmHg. In addition to the cavernous blood puncture, the sympathetic nerve stimulant ethylephrine was also injected into the cavernous cavity. Thromboprophylaxis with enoxaparin sodium (40mg, 2 times/day). Eventually, the patient was successfully extubated after 14 days of mechanical ventilation. In the ICU, there was no embolism elsewhere in the patient, and no local recurrent thromboembolism occurred, and he was subsequently transferred to the ward.

Abnormal penile erection means that the penis continues to erect for more than 4 hours with irrelevant interest and stimulation. According to the pathophysiological mechanism, it can be divided into ischemic abnormal erection, also known as low flow or venous abnormal erection and non-ischemic abnormal erection, also known as high flow or arterial abnormal erection. The patient’s clinical manifestations, blood gas analysis, and the appearance of a black blood clot in the cavernous blood puncture strongly supported his ischemic-related penile erection, but no other diagnosis of ischemia was found. The patient developed penile erection for the first time and did not receive known treatments to promote penile erection, such as propofol sedatives.

COVID-19 patients can indeed have three factors that promote thrombosis, high viscosity, hypercoagulability and structural vascular wall injury-related endothelial cell dysfunction. In this patient, relevant indicators of easy to occur (in inflammatory conditions) hypercoagulability were found, such as C-reactive protein, calcitonin Increased fibrinogen, fibrinogen and serum ferritin. Cytokine storm can also cause focal microvascular inflammation, trigger endothelial cell activation, and eventually trigger thrombosis.

Although this case supports the causal relationship between COVID-19 and abnormal penile erection, the argument of the ischemic mechanism of abnormal penile erection is also very sufficient, but more cases are needed to strengthen this A piece of evidence.

Wuhan University Central South Hospital also reported similar results. Among critically ill patients with new coronary pneumonia, Deep The incidence of venous thrombosis is as high as 85.4%, and the widespread formation of deep venous thrombosis may be an important cause of death or poor prognosis in critically ill patients with COVID-19. Specifically (Wuhan University Central South Hospital published the important research results of new coronary pneumonia in the global cardiovascular top magazine”Circulation”)

The above research is a more in-depth study of the causes and causes of death of patients with new coronary pneumonia in the future The pathogenesis provides a new direction, and it also provides a certain guiding significance for the treatment of new coronary pneumonia that continues to spread globally, especially critical new coronary pneumonia.

References:

Priapism in a patient with coronavirus disease2019 (COVID-19):A case report. Lamamri, Myriam; Chebbi, Ala; Mamane, Jordan; Abbad, Sofia; Munuzzolini, Milena; Sarfati, Florence; Legriel, Stéphane. TheAmerican Journal of Emergency Medicine; 2020.

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