Iinuma Shin, Kobayashi Takahiro, Nagashima Takahiro
Dermatology, Japanese Red Cross Kitami Hospital, Kitami, JPN.
Dermatology, Asahikawa Medical University, Asahikawa, JPN.
Cureus. 2025 Mar 27;17(3):e81324. doi: 10.7759/cureus.81324. eCollection 2025 Mar.
Rectus sheath hematoma (RSH) is a rare cause of acute abdominal pain that is often associated with trauma, anticoagulant therapy, or coagulopathy. We present a unique case of an RSH as a cutaneous manifestation of essential thrombocythemia (ET), which is a myeloproliferative neoplasm characterized by thrombotic and hemorrhagic complications. A 66-year-old female patient presented with acute lower abdominal pain, a subcutaneous mass, and overlying skin ecchymosis. Imaging confirmed a significant RSH. Laboratory tests revealed severe anemia and marked thrombocytosis. Further evaluations, including bone marrow biopsy and genetic testing, revealed ET with a mutation. RSH was managed conservatively, and cytoreductive therapy comprising hydroxyurea was administered for ET, resulting in resolution of the hematoma and improvement in hematological parameters. This case highlights the necessity of considering hematological disorders when patients present with spontaneous hematomas. Prompt diagnosis and effective management of both the hematoma and ET were achieved, demonstrating that timely recognition and appropriate treatment are important to improving patient outcomes.
腹直肌鞘血肿（RSH）是急性腹痛的罕见原因，常与创伤、抗凝治疗或凝血病相关。我们报告了一例独特的腹直肌鞘血肿病例，其为原发性血小板增多症（ET）的皮肤表现，原发性血小板增多症是一种以血栓形成和出血并发症为特征的骨髓增殖性肿瘤。一名66岁女性患者出现急性下腹痛、皮下肿块及皮肤瘀斑。影像学检查证实存在明显的腹直肌鞘血肿。实验室检查显示严重贫血和显著的血小板增多。进一步评估，包括骨髓活检和基因检测，发现该患者患有原发性血小板增多症且存在一种突变。腹直肌鞘血肿采用保守治疗，对原发性血小板增多症给予包含羟基脲的减细胞治疗，血肿得以消退，血液学参数得到改善。该病例强调了在患者出现自发性血肿时考虑血液系统疾病的必要性。对血肿和原发性血小板增多症均实现了及时诊断和有效管理，表明及时识别和恰当治疗对于改善患者预后至关重要。
