Primary Thrombocythemia Associated with Right Hemiparesis, Refractory Ulcer of Left Toe and Renovascular Hypertension

Abstract

A 43-year-old woman was admitted because of her severe hypertension and cerebral thrombosis.
Past history was remarkable in that she had repeated episodes of ulcer formation in her toes for last two years.
Physical examination on admission showed an ulcer in a left toe.
Laboratory data including CBC, NAP score and chromosome analysis were consistent with the diagnosis of primary thrombocythemia.
Aortogram demonstrated severe stenosis at the beggining of a left renal artery.
Marked elevation of plasma renin activity was found in the left renal vein.
The administration of captopril (an angiotensin I converting-enzyme inhibitor) from the 5th hospital day resulted in prompt normalization of blood pressure and complete healing of the refractory toe ulcer was achieved after a few weeks.
Captopril as a potent vasodilator appeared to be efficacious for the treatment of the refractory ulcer in this patient.