The coronavirus is mostly known to cause pulmonary disease such as pneumonia or acute respiratory distress syndrome,however,during the course of this pandemia,it exhibits some extrapulmunary manifestations including hematologic,neurologic,cardiovascular,gastrointestinal and renal manifestations .(7-11)This pathology may be due to extracellular proliferation of the Covid-19 virus and the induction of immunopathological reactions,as it has been reported previously for other zoonotic coronaviruses in the literature.(12)

coagulopathy as a part of the systemic inflammatory response syndrome is a prevalent feature of COVID-19 infection. Roughly 20% to 50% of hospitalized patients with COVID-19 infection have abnormal coagulation tests (elevated D-dimer, prolonged PT, prolonged clotting time, thrombocytopenia and low fibrinogen levels) which can cause thrombosis and microvascular occlusion,due to endothelial dysfunction, cytokine storm, hypoxia and immobilization .(13-19).Increased D-dimer leads to consumption of natural coagulation inhibitors that can cause vascular thrombosis.(20)

Venous drainage of the penis is performed through the following pathways:1) The superficial dorsal venous system,which is responsible for draining the skin and soft subcutaneous tissue,which is eventually drained in to the external pudendal vein that is anatomically linked to the long saphenous vein at the groin and 2) The deep dorsal venous system,which is responsible for draining of the glans, corpus spongiosum and the distal two thirds of corpora cavernosa,and is eventually drained in to the prostatic and perivesical venous system.(4, 21)

The pathogenesis of thrombophlebitis is the well-known Virchow triad which was introduced in 1845:1)Endothelial vascular wall damage,2)venous stasis and 3)changes in blood components.(22)

The cause of thrombosis in the penis is mostly thrombosis of superficial venous system,which is known as Mondor disease.But deep vein thrombosis has been reported very rarely in the literature.(4)

The etiology of Mondor disease is unknown,but some etiologies listed below are reported in the previous studies:  sexual activity ,infection , penis injection, direct trauma, cancer, and a deficit of antithrombin III, Protein C and S and previous surgical hernia repair.(3)Patients with Mondor disease are usually asymptomatic but some of them may have penile pain,erythema of the penis or palpable superficial thrombosed vein.Overally,Mondor disease is self limiting and just need conservative treatments, and in most cases it will not have any complications.(2).As mentioned before,Deep dorsal penile vein thrombosis is very rare compared to the superficial vein thrombosis and the most common cause of spontaneous dorsal deep vein thrombosis is coagulation disorders without inflammatory processes.Since this vein is a part of deep venous system,thrombosis of deep dorsal penile vein can increase the risk of pulmonary embolism leading to significant increase in mortality and morbidity.(23, 24)So investigation for other sites of thrombosis and starting appropriate treatment is nessecary.(24, 25)

Searching the literature showed no previously published similar case of deep dorsal penile vein thrombosis fallowing Covid-19 infection and our patient is the first reported case.Only superficial dorsal penile vein thrombosis are reported previously.(19, 25) (By Eren MT et al and Levine ML et al).

The association between deep dorsal penile vein thrombosis and COVID-19 infection has not been well clarified in the literature.

In this particular case, the treatment started with Rivaroxaban15 mg twice a day for 21 days.Days after this treatment,,the patient’s symptoms were relatively reduced.