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Bilateral adrenal and pulmonary haemorrhages as an initial presentation of polycythaemia vera
  1. Kyle Cilia1,
  2. Janice Borg2,
  3. Maria Bugeja2 and
  4. Emanuel Farrugia2
  1. 1Department of Medicine, Mater Dei Hospital, Msida, Malta
  2. 2Renal division, department of Medicine, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Kyle Cilia; kyle.a.cilia{at}


We report a case of a man in his early 60s presenting with bilateral adrenal and pulmonary haemorrhages as an initial presentation of polycythaemia vera (PV). Symptomatology included severe compressive chest pain radiating to epigastrium, with unremarkable physical findings, parameters and ECG. Blood investigations showed an elevated haemoglobin (174 g/L, reference range (RR): 141-172g/L) and haematocrit (55.7%, RR: 40.4%–50.4%) levels.

Cross-sectional imaging excluded aortic dissection, but imaging repeated 48 hours after his admission for acute dyspnoea and worsening abdominal pain showed bilateral alveolar and adrenal haemorrhages. Cortisol level was 27 nmol/L (RR: 145–619 nmol/L). Investigations confirming PV included the presence of a Janus kinase 2 (JAK2V617F) gene mutation, hypercellularity with erythroid hyperplasia on bone marrow microscopy and a low serum erythropoietin (2.6 mIU/mL, RR: 4.3–29.0 mIU/mL). Aspirin, hydroxyurea, venesection and cortisol replacement were initiated to get good treatment outcome.

  • Adrenal disorders
  • Haematology (incl blood transfusion)
  • Respiratory medicine
  • Endocrine system

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  • Contributors KC wrote and designed the manuscript. MB and JB helped in editing the final draft, all under the supervision of EF.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.