A 62-year-old man presented to the emergency department with painless loss of vision in his left eye.
The patient had a history of essential coagulopathy (Hydrea®, 500 mg, Bristol-Myers, Squibb) and acetylsalicylic acid (Adirocit®, 300 mg, Bayer) for one year.
In the exploration, the corrected visual acuity of the RE was 0.6 and that of the LE 0.02.
Anterior pole biomycosis was normal, with applanation tension of 18 mmHg in RE and 20 mmHg in LE.
Fundus examination revealed venous tortuosity with multiple cotton-type exudates with optic nerve papilla edema and diffuse hemorrhages.
Macular edema was also evident.
The platelet count at that time was 556,000 platelets/mm3, the lowest figure achieved during its evolution, with 9000 white cells/mm3, 41% hematocrit and 14% hemoglobin.
Bone marrow biopsy showed erythropoiesis and hyperplastic myelopoiesis with mature and complete forms, highlighting an increase in dysplastic and atypical megakaryocytes.
One month later, the patient was admitted to the emergency department with massive bleeding in the right hemisphere and died 14 hours later.
