Peripheral gangrene as the initial manifestation of polycythaemia vera

Peripheral gangrene is an uncommon initial manifestation of polycythaemia vera, especially if it is not associated with occlusive disease of larger vessels of the limbs. A 57-year-old Chinese male with polycythaemia vera presenting with recurrent gangrene of the toes is described. Absence of occlusive arterial disease of larger vessels was shown by the presence of peripheral pulses. The digital gangrene was due most probably to impaired perfusion resulting from hyperviscosity. Correction of hyperviscosity in this case by venesection and treatment with the cytotoxic drug, busulphan, not only corrected the polycythaemia vera, but also cured the digital gangrene.