Black toe

A 58 year old man presents with pain and blackish discoloration of his right little toe for 1 week, in a background of exertional dyspnea, fatiguability and intermittent headaches for 4 months. No other symptoms are present.

He has no known medical conditions and has never smoked. At a recent checkup, a fasting blood sugar, lipid profile, liver and renal profile, ECG, chest x-ray and echocardiogram were found to be normal.

Select Relevant Investigations
Full Blood Count

Performed

WBC: 14,500/mm3 (N:73%)
Hb: 18.5 g/dl
Hct: 60%
Platelet: 846,000/mm3
Blood film: Normocytic-normochromic erythrocytosis, neutrophilia with a left shift and thrombocytosis with normal morphology. No abnormal cells.
Ultrasound Abdomen

Performed

The ultrasound scan of the abdomen shows minimal splenomegaly. No other abnormalities are present.
Bone marrow biopsy

Performed

The bone marrow biopsy shows a hypercellular marrow with prominent erythroid, granulocytic and megakaryocytic proliferation. No abnormal cells are seen.
Erythropoietin level

Performed

The serum erythropoietin level is 2.3 mU/ml (normal range: 4.3 to 32.9)

Select Relevant Management
Anti-platelet therapy
Antibiotics
Phlebotomy
Steroids