Ischemia of toes as a presenting symptom in primary thrombosis: a case report.

Although thrombotic occlusion of small vessels in thrombocytosis is allegedly well recognized, it has been reported only rarely. We treated 4 patients with primary thrombocytosis in whom ischemic toe lesions with normal peripheral pulses were the presenting and only symptoms. The symptoms preceded diagnosis by 5 years, 3 years, 1 year, and 1 month respectively. Treatment of the hematologic disorder resulted in disappearance of the toe lesions. Thrombocytosis should be routinely searched for in patients with ischemic toes and normal peripheral pulses.