Olanzapine-Induced Priapism

Mr. A was a 35-year-old white man who was admitted to a partial hospitalization program for patients with suicidal thoughts and paranoia. He had neither a prior history of mental illness nor a history of psychotropic medication use. Mr. A came in for treatment with paranoid delusions and suicidal thoughts and was diagnosed with schizoaffective disorder. Treatment with 10 mg of olanzapine at bedtime was initiated. Approximately 14 hours after his first and only dose of olanzapine, Mr. A developed a painful erection. He did not report this to anyone at the time and returned to the partial hospitalization program 48 hours later. By this time he was in significant discomfort and acknowledged that his pain was due to an erection that had been present for approximately 2 days. He was immediately taken to the emergency room for a urological consultation.

A urologist attempted evacuation of blood from Mr. A’s penis without success. Mr. A was then taken to the operating room, where blood was evacuated and phenylephrine was injected; flaccidity was obtained and lasted for 1 hour before the erection returned. Mr. A was taken back to the operating room, and a corporeal glandular shunt was placed, but this too was unsuccessful in alleviating the erection. He was then transferred to another hospital for possible insertion of a proximal shunt, which was not performed because of the length of time since the onset of priapism. Symptomatic relief was provided with oral analgesics; eventual detumescence of the penis followed. Permanent impotence resulted from Mr. A’s prolonged priapism.