Patil Vijaya L, Chavan Deepak R, Thimmarayappa Yashaswini, Mathias Linette P
General Surgery, Shri B. M. Patil Medical College, Hospital and Research Centre, Vijayapura, IND.
Cureus. 2024 Sep 29;16(9):e70426. doi: 10.7759/cureus.70426. eCollection 2024 Sep.
Digital ischemia with gangrene is a rare manifestation of chronic myeloid leukemia (CML). We report a rare CML case with severe thrombocytosis presenting clinically as digital ischemia and gangrene, the sole primary symptom. A 40-year-old patient presented with pain and discoloration of the tips of the ring and little fingers of the right hand for 20 days, which later progressed to dry gangrene with a line of demarcation and pre-gangrenous changes in the index and middle fingers. He was a chronic smoker and alcoholic with no other comorbidities. On investigation, he was found to have abnormal leukocytosis (153,000/mm) and moderate thrombocytosis (969,000/mm) with anemia. In view of abnormal leukocytosis, he was investigated for leukemia. He was found to be positive for BCR-ABL by reverse transcription polymerase chain reaction (RT-PCR), thus confirming the diagnosis of CML. He received imatinib 400 mg/day and subsequently experienced resolution of symptoms and complete hematological response by the 12th week of therapy.
伴有坏疽的指端缺血是慢性髓性白血病（CML）的一种罕见表现。我们报告一例罕见的CML病例，该病例有严重的血小板增多症，临床上表现为指端缺血和坏疽，这是唯一的主要症状。一名40岁患者右手环指和小指指尖疼痛、变色20天，随后发展为干性坏疽，有分界线，示指和中指出现坏疽前期变化。他是一名长期吸烟者和酗酒者，无其他合并症。经检查，发现他有异常白细胞增多（153,000/mm）、中度血小板增多（969,000/mm）并伴有贫血。鉴于异常白细胞增多，对他进行了白血病检查。通过逆转录聚合酶链反应（RT-PCR）发现他的BCR-ABL呈阳性，从而确诊为CML。他接受了每天400毫克伊马替尼治疗，随后在治疗第12周时症状缓解，血液学完全缓解。
