To the Editor.—
Polycythemia vera is a myeloproliferative disorder of unknown cause. The elevated red blood cell count induces hyperviscosity and hypervolemia, which result in circulatory disturbances in many organs. Central nervous system symptoms, visual disturbances, angina pectoris, and intermittent claudication have been recognized as complications of this disorder. Therefore, early diagnosis is important in order to prevent such serious complications. We recently observed a patient with tiny painful subcutaneous nodules due to digital arterial occlusions as the first and sole clinical sign of polycythemia vera.
Report of a Case.—
On January 6, 1989, a 66-year-old man presented with a few painful lesions at the base of the right thumb and on the medial aspect of the right index finger. One day before developing the symptoms, he had held a fishing rod in the right hand for a long time. On examination, each of the lesions was an ill-defined nodule,