Cavernosal Abscess Mimicking Ischemic Priapism in a Diabetic Patient: A Report of a Rare Case.

Cavernosal abscesses are extremely rare and an even rarer precipitant of ischemic priapism. These abscesses may arise due to trauma, intracavernosal injection therapy, foreign bodies, or complications of perianal and perineal infections. Hematogenous spread from distant sources, including dental infections, has also been documented. Diabetic individuals are particularly susceptible due to their immunocompromised status, microvascular disease, and poor glycemic control. Delayed diagnosis risks fibrosis and lifelong erectile dysfunction. A 56-year-old man with poorly controlled type-2 diabetes (HbA1c 10.2 %) presented with fever and painful low-flow priapism of two hours duration. Inspection revealed a perineal abscess that opened and expressed approximately 60 mL of purulent material, resulting in immediate detumescence. A pelvic 3-T MRI performed 40 minutes later demonstrated a T2 hyperintense collection showing diffusion restriction, measuring 7.3 × 5.1 × 7.6 cm, with a volume of 132 cc noted in the left corpora cavernosa and perineum. Intravenous cefoperazone-sulbactam plus metronidazole was started and de-escalated to amoxicillin-clavulanate after cultures grew methicillin-sensitive Staphylococcus aureus. On hospital day 2, a 1-cm perineal incision allowed blunt evacuation and gentamicin-saline irrigation; the drain was removed after 48 hours. Adjuvant tadalafil 5 mg daily and intensified insulin therapy were continued for six weeks. At six months, the patient reported satisfactory erectile function, including normal rigidity and the ability to complete intercourse without the use of pharmacological support. In diabetic men presenting with painful priapism, the presence of a small perineal abscess should raise suspicion of an underlying cavernosal abscess. Early MRI delineation, combined with minimal drainage and culture-directed antibiotics, can eradicate the infection while preserving erectile function.