Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
BMJ Case Rep. 2024 Oct 7;17(10):e261063. doi: 10.1136/bcr-2024-261063.
We report a case of gangrene and osteomyelitis of the toe in a young, previously healthy male with undiagnosed essential thrombocythemia (ET). The patient experienced persistent right fifth toe pain, discolouration and ulceration for 3-4 months, unresponsive to antibiotics. Despite multiple normal X-rays, 2 months later, MRI revealed osteomyelitis. On inpatient admission, testing revealed thrombocytosis and abnormal blood flow to right fourth and fifth toes without thrombus, consistent with vasospasm. This ultimately resulted in ischemia, gangrene and osteomyelitis of the toe, necessitating amputation. The patient was subsequently treated with hydroxyurea for ET. This unusual presentation underscores the importance of a broad differential in cases when conventional treatments fail to yield improvement.
我们报告一例年轻、既往健康的男性患者发生脚趾坏疽和骨髓炎，该患者患有未经诊断的原发性血小板增多症（ET）。患者持续出现右侧第五脚趾疼痛、变色和溃疡达 3-4 个月，对抗生素治疗无反应。尽管多次进行了正常 X 射线检查，但 2 个月后 MRI 显示骨髓炎。住院时，检查显示血小板增多和右侧第四和第五脚趾血流异常，但无血栓，符合血管痉挛。这最终导致脚趾缺血、坏疽和骨髓炎，需要截肢。患者随后接受羟基脲治疗 ET。这种不常见的表现强调了在常规治疗无效时，需要广泛考虑鉴别诊断的重要性。
