Recurrent unilateral dactylitis as an unusual presenting manifestation of polycythemia vera: a case report

Abstract

Polycythemia Vera is a chronic myeloproliferative neoplasm characterised by clonal proliferation of erythroid, myeloid, and megakaryocytic cell lines. Typical clinical manifestations include headache, aquagenic pruritus, erythromelalgia, thrombotic events, and splenomegaly. However, atypical presentations may delay diagnosis. We report a rare case of recurrent unilateral dactylitis-like swelling as the presenting manifestation of polycythemia vera in a middle-aged woman. The patient was initially treated for presumed cellulitis because leucocytosis was interpreted in isolation, while the accompanying erythrocytosis and thrombocytosis were overlooked. Recurrent episodes prompted further evaluation, which demonstrated hypercellular bone marrow with panmyelosis and a positive JAK2 V617F mutation, confirming the diagnosis of polycythemia vera”. This case highlights the importance of careful interpretation of complete blood counts, detailed clinical history taking, and maintaining suspicion for haematological disorders in patients presenting with recurrent inflammatory digit swelling.