Digital Ischemia and Gangrene: An Unusual Presentation of Chronic Myeloid Leukemia

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/mm³) and moderate thrombocytosis (969,000/mm³) 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.