Postcoital generalised pruritus as a first symptom of polycythaemia vera

Ploycythaemia vera (PV) is most common of chronic myeloproliferative disorder that involves the multipotent haemaotopoietic progenitor cells. PV has indolent course and recognised either by incidental discovery of high haemoglobin or haemtocrit. PV may present with aquagenic pruritus (AP) for years together without any other sign and symptoms. So advice of simple complete bood count as a routine in every case of pruritus can be helpful to diagnose it timely thereby dreaded complications of PV, related to hyperviscosity of blood like thrombosis both arterial and venous can be managed antecedently. A 50-year-old male doctor diagnosed as a case of PV presented to us with postcoital generalised pruritus (PCP) as a first, rarest symptoms and he remained undiagnosed for 10 years till he developed other features of PV like aquagenic pruritus, headache, red congestion in eyes and erythromelalgia symptoms complex erythema, burning pain and warmness of lower extremities. Then he was investigated and was found to have high haemoglobin or haemtocrit, JAK 2 genetic mutation changes were present, bone marrow biopsy and other biochemical investigations confirmed the diagnosis of PV. Initially he was managed with repeated phlebotomy to bring down high haemtocrit value in acceptable range (approximately 45%). Simultaneously he was put on hydroxyurea 500 mg twice daily doses. Since then his symptoms improved and monthly blood count was done to monitor the haemtocrit. So advice of simple blood count is highly informative in every case of generalised pruritus.