Penile Tourniquet Injury in a Patient With Schizoaffective Disorder Presenting With Altered Mental Status.

Penile tourniquet syndrome is a rare urologic emergency that can lead to ischemia, necrosis, and long-term functional impairment if not promptly recognized and treated. We present the case of a 52-year-old incarcerated male with a history of schizoaffective disorder who presented with altered mental status initially concerning for an acute cerebrovascular event. Further evaluation revealed a self-inflicted penile tourniquet using a sock in the setting of command auditory hallucinations. The patient developed significant penile edema, ischemic changes, and urinary retention requiring catheterization. Despite initial improvement with conservative management, follow-up demonstrated tissue sloughing of the glans with concern for long-term reconstructive needs. This case highlights the importance of thorough physical examination in patients with altered mental status, the role of psychiatric illness in self-inflicted injury, and the potential for delayed complications even with early intervention.