# Transient penile erection following lumbar puncture with intrathecal prophylaxis in primary testicular diffuse large B-cell lymphoma: a case report

## TL;DR

A rare case of transient penile erection after a lumbar puncture in a man with testicular lymphoma is reported, highlighting unusual neurological responses to the procedure.

## Contribution

This case report documents a rare neurogenic reflex erection following intrathecal prophylaxis in a patient with primary testicular lymphoma.

## Key findings

- A 51-year-old man with PT-DLBCL experienced a transient penile erection 30 minutes after a lumbar puncture.
- No further episodes occurred after additional treatments, suggesting the event was isolated and possibly neurogenic in origin.
- The case underscores the need for vigilance and procedural refinement in patients undergoing multiple intrathecal treatments.

## Abstract

Primary testicular diffuse large B-cell lymphoma (PT-DLBCL) is a rare and aggressive extranodal non-Hodgkin lymphoma that predominantly affects older men and carries a relatively high risk of central nervous system (CNS) relapse. Although lumbar puncture with intrathecal prophylaxis is commonly employed to reduce CNS involvement, transient penile erection after this procedure is extraordinarily rare. This case report describes a 51-year-old man diagnosed with PT-DLBCL (stage IA) who underwent right radical orchiectomy, followed by six cycles of R2-CHOP chemotherapy with intrathecal prophylaxis prior to each cycle. Approximately 30 minutes after the sixth lumbar puncture, the patient developed a transient penile erection that persisted for approximately three hours before resolving spontaneously without intervention. He later received additional cycles of R-HD-MTX and scrotal radiotherapy, and no further episodes of penile erection or disease recurrence were observed. This clinical vignette highlights the potential for rare neurogenic reflex erections associated with repeated lumbar punctures, underscoring the importance of heightened vigilance, procedural refinement, and close monitoring in patients receiving multiple intrathecal treatments.