Superficial Thrombophlebitis

September 14, 2005
Jonathan S. Crane, MD

,
Reynold C. Wong, MD

A patchy, macular, erythematous area developed on the dorsum of a 63-year-old woman's left foot 4 months ago. Because the lesion was asymptomatic and she was otherwise healthy, no workup was instituted at that time. The affected area subsequently became ulcerated, tender, and painful. The patient now had a 1.2-cm ulcer covered by a dried, hemorrhagic crust and surrounded by a livedo reticularis–like pattern. The entire area was extremely tender.

A patchy, macular, erythematous area developed on the dorsum of a 63-year-old woman's left foot 4 months ago. Because the lesion was asymptomatic and she was otherwise healthy, no workup was instituted at that time. The affected area subsequently became ulcerated, tender, and painful. The patient now had a 1.2-cm ulcer covered by a dried, hemorrhagic crust and surrounded by a livedo reticularis–like pattern. The entire area was extremely tender.

The patient's distal pedal pulses were strong. Results of a complete blood cell count included: white blood cells, 15,500/µL; red blood cells, 7.7 million/µL; hemoglobin, 18.5 g/dL; hematocrit, 59.9%; and platelet count, 845,000/µL. A biopsy revealed superficial thrombophlebitis. The diagnosis was polycythemia vera, a disease marked by proliferation of all three components of bone marrow: erythrocytes, leukocytes, and platelets.

Affected patients typically appear plethoric, writes Dr Reynold C. Wong of Sacramento, Calif; they may have a ruddy complexion because of distended cutaneous vasculature. Other findings may include petechiae, ecchymoses, severe pruritus, erythromelalgia, arterial thrombosis, cold sensitivity, neurologic signs, thrombophlebitis, leg ulcers, and livedo reticularis.

This patient's ulcer healed, leaving only a scar, after several months of phlebotomy.