Leo E, Krämer A, Hochhaus A, Krasniqi F, Hehlmann R, Ho A D
Universitätsklinikum Heidelberg, Abteilung für Hämatologie, Onkologie und Rheumatologie, Hospitalstr. 3, 69115 Heidelberg, Germany.
Ann Hematol. 2002 Aug;81(8):467-9. doi: 10.1007/s00277-002-0505-0. Epub 2002 Aug 15.
Gangrene of the toes and digits appears to be a rare but very severe complication of long-term hydroxyurea therapy. Nothing is known regarding the pathophysiology and the type of vascular damage leading to this syndrome. Here we report a case of a 49-year-old male presenting with gangrene of the toes of both feet 4.5 years after initiation of hydroxyurea therapy for chronic myelogenous leukemia. Blisters on the toes occurred for the first time 9 months prior to hospitalization. Successively, all ten toes showed signs of beginning gangrene with one toe removed surgically 8 months before admission. Presence of diabetes mellitus or peripheral angiopathy was ruled out and platelet counts were within the physiologic range during the last years, excluding thrombocythemia as another rare cause for gangrene in patients with myeloproliferative diseases. Whereas perimalleolar ulcerations of the legs are a more common complication of hydroxyurea, gangrene of the toes as a consequence of hydroxyurea treatment has been described previously only once in the literature. At this point in time cessation of hydroxyurea treatment appears to be the only therapeutic option, thereby avoiding further progress of gangrene in patients with chronic myelogenous leukemia treated with hydroxyurea.
足趾坏疽似乎是长期使用羟基脲治疗罕见但非常严重的并发症。关于导致该综合征的病理生理学及血管损伤类型尚不清楚。在此，我们报告一例49岁男性患者，在开始使用羟基脲治疗慢性粒细胞白血病4.5年后出现双足趾坏疽。住院前9个月，足趾首次出现水疱。随后，所有10个足趾均出现坏疽迹象，入院前8个月有1个足趾接受了手术切除。排除了糖尿病或外周血管病变，且过去几年血小板计数在生理范围内，排除了血小板增多症作为骨髓增殖性疾病患者坏疽的另一个罕见原因。腿部内踝溃疡是羟基脲更常见的并发症，而羟基脲治疗导致的足趾坏疽此前在文献中仅被描述过一次。此时，停用羟基脲治疗似乎是唯一的治疗选择，从而避免接受羟基脲治疗的慢性粒细胞白血病患者的坏疽进一步发展。
