Penile cyanosis revealing polycythemia vera: A case report

Polycythemia vera is a chronic myeloproliferative neoplasm characterized by excessive erythrocyte production, resulting in increased blood viscosity, impaired microcirculation, and a heightened risk of thrombotic events. It may present with a wide spectrum of cutaneous manifestations related to hyperviscosity and microvascular dysfunction, including erythromelalgia, livedo, pruritus, acral ischemia, and, more rarely, penile cyanosis.
We report the case of a 61-year-old male with no significant medical history, presenting with penile cyanosis associated with a penile blister, preceded by a febrile syndrome and acute urinary retention. Laboratory investigations incidentally revealed polycythemia (hemoglobin 18.5 g/dL), acute renal failure, and myocarditis on transthoracic echocardiography. The patient underwent therapeutic phlebotomy followed by curative anticoagulation with low-molecular-weight heparin and antiplatelet therapy, resulting in favorable clinical evolution, with regression of penile cyanosis and partial healing of post-blister erosions.