One of my patients have recently been diagnosed with polycythemia vera jak 2. She has not other relevant diseases. She is 78 years of and in good health.
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I have been treating her routinely for years with no abnormal presentations. Recently she presented to me with an extremely painful apex of left hallux. The pain was so severe that she is unable to tolerate the weight of her bed sheet or wear occlusive footwear. Initially there was nothing to observe on the toe but after three months of pain, the apex of the toe has a 2x2mm erythematous area. Other than a change in colour of the skin, there are no other changes.
I have done a little research on polycythemia vera jak 2 and due to the hyperviscosity of the blood I suspect a microvascular throbosis.
Has anyone out there seen anything like this before?
Julie
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