A 62-year-old man attended the emergency department for painless loss of vision in the left eye. He had been receiving haematological treatment with hydroxyurea (Hydrea®, 500 mg, Bristol-Myers, Squibb) and acetylsalicylic acid (Adiro®, 300 mg, Bayer) for a year due to essential thrombocythemia with 1,200,000 platelets/mm3. On ophthalmological examination, the corrected visual acuity of the OD was 0.6 and that of the OI 0.02. Anterior pole biomicroscopy was normal, with aplanation stress of 18 mmHg in OD and 20 mmHg in OI. Fundus examination of the OI showed venous tortuosity with multiple juxtapapillary cottony exudates with oedematous optic nerve papilla and diffuse haemorrhages. Macular oedema was also evident. The platelet count at that time was 556,000 platelets/mm3, the lowest figure reached during his evolution, with 9000 white cells/mm3, a haematocrit of 41% and a haemoglobin of 14%.
Bone marrow biopsy showed hyperplastic erythropoiesis and myelopoiesis with mature and complete forms, with an increase in dysplastic and atypical megakaryocytes.
One month later, the patient was admitted to the emergency department with a massive haemorrhage in the right cerebral hemisphere and died 14 hours later.
