{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T09:11:35Z","timestamp":1790241095189,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:00:00Z","timestamp":1758672000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Peripheral gangrenes have been sporadically documented as the initial presentation of essential thrombocythemia (ET), as exemplified in the preceding case reports. Nevertheless, the prevalence of vasculitis\u2010induced skin problems as the primary indication of ET has not been extensively examined. Our case distinguishes itself in this regard, as it proposes a fresh outlook on the etiology of ET. A 52\u2010year\u2010old male presented with worsening pain and bruising in the right toes, following auto\u2010amputation of the left fourth fingertip due to gangrene a month earlier. Examination revealed necrotic wounds on multiple toes. Dorsalis pedis pulses were palpable, and sonography ruled out obstructions. Splenomegaly and thrombocytosis prompted consideration of ET. Marrow analysis confirmed myeloproliferative neoplasia with negative JAK2, CALR, and MPL mutations. Axonal polyneuropathy was evident, and skin biopsy showed leukocytoclastic vasculitis (LCV). The patient was diagnosed with undifferentiated vasculitis, characterized by total signs of ischemia and gangrene of the fingertips, splenomegaly, triple\u2010negative ET, neuropathy (medium vessel involvement), and cutaneous LCV (small vessel involvement). The patient received prednisolone at a dosage of 1\u2009mg\/kg and azathioprine concurrently with hydroxyurea, aspirin, cilostazol, and sildenafil. The results indicate a fresh perspective, suggesting that ET may potentially contribute to the development of LCV. The main takeaway lesson from this atypical manifestation highlights the wide range of clinical manifestations associated with ET and encourages further investigation into the complex relationship between thrombocythemia and vasculitis processes. As we delve deeper into these distinct presentations, we gain a more comprehensive understanding of the diverse aspects of ET pathology.<\/jats:p>","DOI":"10.1002\/ccr3.70963","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T04:10:36Z","timestamp":1758773436000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Essential Thrombocythemia's Role in the Complex Landscape of Vasculitis: A Case Report"],"prefix":"10.1002","volume":"13","author":[{"given":"Mohammad Reza","family":"Jafari Nakhjavani","sequence":"first","affiliation":[{"name":"Connective Tissue Diseases Research Center Tabriz University of Medical Sciences, Imam Reza Hospital  Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyedeh\u2010Tarlan","family":"Mirzohreh","sequence":"additional","affiliation":[{"name":"Student Research Committee Tabriz University of Medical Sciences  Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sousan","family":"Kolahi","sequence":"additional","affiliation":[{"name":"Connective Tissue Diseases Research Center Tabriz University of Medical Sciences, Imam Reza Hospital  Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehrzad","family":"Hajialilo","sequence":"additional","affiliation":[{"name":"Connective Tissue Diseases Research Center Tabriz University of Medical Sciences, Imam Reza Hospital  Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3555-8908","authenticated-orcid":false,"given":"Mehdi","family":"Jafarpour","sequence":"additional","affiliation":[{"name":"Connective Tissue Diseases Research Center Tabriz University of Medical Sciences, Imam Reza Hospital  Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arezou","family":"Ghassembaglou","sequence":"additional","affiliation":[{"name":"Connective Tissue Diseases Research Center Tabriz University of Medical Sciences, Imam Reza Hospital  Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mir Ali","family":"Sattary Oskouie","sequence":"additional","affiliation":[{"name":"Student Research Committee Tabriz University of Medical Sciences  Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tala","family":"Pourlak","sequence":"additional","affiliation":[{"name":"Department of Pathology Tabriz University of Medical Science  Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2635-5793","authenticated-orcid":false,"given":"Sepideh","family":"Tahsini Tekantapeh","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Student Research Committee Tabriz University of Medical Sciences  Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,24]]},"reference":[{"key":"e_1_2_12_2_1","volume-title":"StatPearls [Internet]","author":"Baigrie D.","year":"2022"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.8769"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.9244"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41408-017-0041-8"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.22631\/rr.2018.69997.1058"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000000009"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2010.09.732"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/2634853520978210"},{"issue":"7","key":"e_1_2_12_10_1","article-title":"Toe Gangrene as the First Presenting Symptom of Essential Thrombocythemia: A Case Report","volume":"15","author":"Altayyan M. 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