Today’s mystery has two parts: an underlying diagnosis, and the name of a complication of this disorder. Can you guess one – or both?
A 60 year old goes to the doctor because her feet become red, hot, and painful. She has had this condition for years, with intermittent episodes usually involving both feet, but sometimes one or the other. These episodes last anywhere from minutes to days. Sometimes a hot shower will precipitate an episode – first she feels itching, which then builds to a painful burning sensation, and her feet become swollen and red. She has noticed that taking an aspirin improves these symptoms. She otherwise feels well, and has no medical problems.
The patient’s vital signs are normal, including the oxygen saturation in her blood. Her feet currently appear normal, but she shows the doctor a picture on her cell phone of her feet during an episode (shown below). The abdominal exam reveals an enlarged spleen, and the rest of the physical is normal. Suspecting a certain diagnosis, the doctor sends the patient for a blood count. All elements of it are high (red blood cells, white blood cells, and platelets). The doctor also examines a drop of her blood under a microscope, with the findings below.
What is the most likely underlying diagnosis?
What is the name of the complication this patient has developed?