{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T16:13:47Z","timestamp":1758125627357,"version":"3.44.0"},"reference-count":5,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,9,25]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:p>We report a case of gangrene and osteomyelitis of the toe in a young, previously healthy male with undiagnosed essential thrombocythemia (ET). The patient experienced persistent right fifth toe pain, discolouration and ulceration for 3\u20134 months, unresponsive to antibiotics. Despite multiple normal X-rays, 2 months later, MRI revealed osteomyelitis. On inpatient admission, testing revealed thrombocytosis and abnormal blood flow to right fourth and fifth toes without thrombus, consistent with vasospasm. This ultimately resulted in ischemia, gangrene and osteomyelitis of the toe, necessitating amputation. The patient was subsequently treated with hydroxyurea for ET. This unusual presentation underscores the importance of a broad differential in cases when conventional treatments fail to yield improvement.<\/jats:p>","DOI":"10.1136\/bcr-2024-261063","type":"journal-article","created":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T23:00:11Z","timestamp":1728342011000},"page":"e261063","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Gangrene and osteomyelitis of the toe in a previously healthy patient due to undiagnosed essential thrombocythemia"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3015-9138","authenticated-orcid":false,"given":"Alex","family":"Schick","sequence":"first","affiliation":[{"name":"Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit S","family":"Dhamoon","sequence":"additional","affiliation":[{"name":"Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,10,7]]},"reference":[{"key":"2025082802233879000_17.10.e261063.1","doi-asserted-by":"crossref","DOI":"10.1177\/2634853520978210","article-title":"The Essential Thrombocythemia in 2020: What We Know and Where We Still Have to Dig Deep","volume":"13","author":"Accurso","year":"2020","journal-title":"Clin Med Insights Blood Disord"},{"key":"2025082802233879000_17.10.e261063.2","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/j.hoc.2017.08.007","article-title":"Myeloproliferative Disorders","volume":"31","author":"Meier","year":"2017","journal-title":"Hematol Oncol Clin North Am"},{"key":"2025082802233879000_17.10.e261063.3","doi-asserted-by":"publisher","DOI":"10.1016\/0190-9622(91)70010-Y"},{"key":"2025082802233879000_17.10.e261063.4","article-title":"Toe Gangrene as the First Presenting Symptom of Essential Thrombocythemia: A Case Report","volume":"15","author":"Altayyan","year":"2023","journal-title":"Cureus"},{"key":"2025082802233879000_17.10.e261063.5","doi-asserted-by":"crossref","DOI":"10.1155\/2016\/9675171","article-title":"Myeloproliferative Disease: An Unusual Cause of Raynaud\u2019s Phenomenon and Digital Ischaemia","volume":"2016","author":"Beynon","year":"2016","journal-title":"Case Rep Med"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-261063","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T09:23:50Z","timestamp":1756373030000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-261063"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":5,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2024,10,7]]},"published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1136\/bcr-2024-261063"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-261063","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,10]]}}}