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

• Published in: Curēus (Palo Alto, CA) Vol. 16; no. 9; p. e70426
• Main Authors: Patil, Vijaya L, Chavan, Deepak R, Thimmarayappa, Yashaswini, Mathias, Linette P
• Format: Journal Article
• Language: English
• Published: United States Cureus 29.09.2024
• Subjects: General Surgery; Hematology; Internal Medicine; digital ischemia; chronic myeloid leukemia (cml); leukostasis; digit gangrene; hyperviscosity
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.70426

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