{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:40:04Z","timestamp":1756309204305,"version":"3.44.0"},"reference-count":16,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,12,1]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:p>We report a case of a man in his early 60s presenting with bilateral adrenal and pulmonary haemorrhages as an initial presentation of polycythaemia vera (PV). Symptomatology included severe compressive chest pain radiating to epigastrium, with unremarkable physical findings, parameters and ECG. Blood investigations showed an elevated haemoglobin (174 g\/L, reference range (RR): 141-172g\/L) and haematocrit (55.7%, RR: 40.4%\u201350.4%) levels.<\/jats:p>\n               <jats:p>Cross-sectional imaging excluded aortic dissection, but imaging repeated 48\u2009hours after his admission for acute dyspnoea and worsening abdominal pain showed bilateral alveolar and adrenal haemorrhages. Cortisol level was 27\u2009nmol\/L (RR: 145\u2013619\u2009nmol\/L). Investigations confirming PV included the presence of a Janus kinase 2 (JAK2V617F) gene mutation, hypercellularity with erythroid hyperplasia on bone marrow microscopy and a low serum erythropoietin (2.6 mIU\/mL, RR: 4.3\u201329.0 mIU\/mL). Aspirin, hydroxyurea, venesection and cortisol replacement were initiated to get good treatment outcome.<\/jats:p>","DOI":"10.1136\/bcr-2022-252013","type":"journal-article","created":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T09:41:01Z","timestamp":1670492461000},"page":"e252013","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Bilateral adrenal and pulmonary haemorrhages as an initial presentation of polycythaemia vera"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7125-736X","authenticated-orcid":false,"given":"Kyle","family":"Cilia","sequence":"first","affiliation":[{"name":"Department of Medicine, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janice","family":"Borg","sequence":"additional","affiliation":[{"name":"Renal division, department of Medicine, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Bugeja","sequence":"additional","affiliation":[{"name":"Renal division, department of Medicine, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuel","family":"Farrugia","sequence":"additional","affiliation":[{"name":"Renal division, department of Medicine, Mater Dei Hospital, Msida, Malta"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,12,8]]},"reference":[{"key":"2025082708100718000_15.12.e252013.1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2404955"},{"key":"2025082708100718000_15.12.e252013.2","doi-asserted-by":"publisher","DOI":"10.4065\/78.2.174"},{"key":"2025082708100718000_15.12.e252013.3","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.281"},{"key":"2025082708100718000_15.12.e252013.4","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2008.113"},{"key":"2025082708100718000_15.12.e252013.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2014.12.002"},{"key":"2025082708100718000_15.12.e252013.6","doi-asserted-by":"publisher","DOI":"10.1038\/bcj.2015.64"},{"key":"2025082708100718000_15.12.e252013.7","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.23585"},{"key":"2025082708100718000_15.12.e252013.8","first-page":"S36","article-title":"Diagnosis and management of polycythemia vera: proceedings from a multidisciplinary roundtable","volume":"7","author":"Raedler","year":"2014","journal-title":"Am Health Drug Benefits"},{"key":"2025082708100718000_15.12.e252013.9","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.07.062"},{"key":"2025082708100718000_15.12.e252013.10","doi-asserted-by":"crossref","DOI":"10.3402\/jchimp.v6.32416","article-title":"Bilateral adrenal hemorrhage in polycythemia vera","volume":"6","author":"Bhandari","year":"2016","journal-title":"J Community Hosp Intern Med Perspect"},{"key":"2025082708100718000_15.12.e252013.11","article-title":"Bilateral adrenal hemorrhage in polycythemia vera","volume":"92","author":"Gelfand","year":"1992","journal-title":"N Y State J Med"},{"key":"2025082708100718000_15.12.e252013.12","first-page":"132","article-title":"Polycythaemia vera presented with bilateral adrenal haemorrhage and adrenal insufficiency: a case report","volume":"66","author":"G\u00f6nen","year":"2011","journal-title":"Acta Clin Belg"},{"key":"2025082708100718000_15.12.e252013.13","doi-asserted-by":"publisher","DOI":"10.1378\/chest.10-0973"},{"key":"2025082708100718000_15.12.e252013.14","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1177\/2045893217702064","article-title":"Pulmonary extra-medullary hematopoiesis and pulmonary hypertension from underlying polycythemia vera: a case series","volume":"7","author":"Singh","year":"2017","journal-title":"Pulm Circ"},{"key":"2025082708100718000_15.12.e252013.15","unstructured":"Mehmood KT , Sharman T , Mehmood KT , et al . Adrenal Hemorrhage. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2022. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK555911\/"},{"key":"2025082708100718000_15.12.e252013.16","unstructured":"Shee B , Anjum F , Rockoff BI . Pulmonary Hemorrhage. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2022. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK538278\/"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-252013","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:10:13Z","timestamp":1756307413000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-252013"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12]]},"references-count":16,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12,8]]},"published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1136\/bcr-2022-252013"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-252013","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2022,12]]}}}