Designated Institutional Officer Burke Rehabilitation Hospital White Plains, New York, United States
Case Diagnosis: Polycythemia Vera Thrombosis, Stroke and Digit Amputations
Case Description: 33-year-old active female athletic trainer with diagnosed Polycythemia Vera (PCV) on aspirin, presented to acute care after presentation of painful paresthesia in bilateral upper extremity digits and left sided hemiplegia. Lab work was notable for erythrocytosis and thrombocytosis. MRI demonstrated acute infarcts involving bilateral frontal, parietal and occipital lobes and right cerebellar hemisphere. Carotid duplex portrayed right internal jugular vein thrombosis. After multiple courses of phlebotomy, patient was started on hydroxyurea. Patient was admitted to acute rehabilitation for further management of ongoing cognitive and left sided deficits. Due to progressing digit ischemia and pain, digit amputations were performed with return to rehabilitation. Hematology was consulted and transition to the JAK2 inhibitor, Ruxolitinib was initiated.
Discussions: Polycythemia Vera can result in many severe complications represented by thromboembolic events. Patients may also present with symptoms that can decrease quality of life and function including numbness in the hands and feet, pruritis, bone pain, inactivity, insomnia and weight loss. Our case presents a unique sudden presentation of complications of PCV in a young active athletic trainer. The acuity, age and lack of comorbid conditions presented in our case is uncommon with such sequalae. The venous and arterial thrombosis in our patient instigated significant cognitive functional disability. The patients left hemiplegic deficits, pain and digit amputation required multidisciplinary rehabilitation to reestablish function and quality of life.
Conclusions: PCV can result in various thromboembolic phenomenon as well as conversion into leukemia and or myelofibrosis. The complications of PCV presented unexpectedly in our patient leading to disability and functional decline. Therefore, it is vital for the physiatrist to understand the pathophysiology and consequences of the disease to reduce risk of recurrent complications and provide better quality of life management. This case represents the need for future comprehensive cancer rehabilitation care.