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Pulmonary puzzles
A surprising cause of polycythaemia
  1. N E De Maeyer1,
  2. S Van Lommel2,
  3. T Devos3,
  4. B Buyse1,
  5. K Nackaerts1
  1. 1Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
  2. 2Department of Psychiatry, University Hospitals Leuven, Leuven, Belgium
  3. 3Department of Hematology, University Hospitals Leuven, Leuven, Belgium
  1. Correspondence to Dr N E De Maeyer, Department of Respiratory Diseases, University Hospitals Leuven, Herestraat 49, Leuven 3000, Belgium; nikolaas.demaeyer{at}uzleuven.be

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Case presentation

A 48-year-old man was referred to the outpatient clinic because of fatigue and an elevated haemoglobin level of 19.4 g/dL. His relevant medical history only revealed psychosis. He had quit cigarette smoking for several years. His daily medication schedule consisted of valproic acid 1500 mg, quetiapine 400 mg and lormetazepam 1 mg daily. There were no clinical abnormalities besides a body mass index of 28.3 kg/m².

Since primary erythrocytosis was not excluded initially, venesections were performed three times. Meanwhile, diagnostic work-up took place. Serum erythropoietin levels and V617F JAK-2 mutation were normal. Red blood cell mass nuclear scintigraphy showed an absolute elevation in red …

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