Abstract
This case report describes the clinical course of a 78-year-old patient diagnosed with polycythemia vera (PV), who presented with pronounced acrocyanosis of the hands in 2021. The patient was treated with hydroxyurea (oncocarbide), and nailfold capillaroscopy revealed an "abnormal pattern" characterized by pronounced architectural disarray and capillary tortuosity, which is uncommon in patients with myeloproliferative neoplasms (MPNs). In 2023, owing to suboptimal symptom management and hematological side effects, the treatment was switched to ruxolitinib, which led to significant clinical improvements by 2024, including near-complete resolution of acrocyanosis and substantial improvement in capillaroscopic abnormalities, with only residual capillary tortuosity noted. This case emphasizes the need for individualized therapeutic interventions for PV, and underscores the potential role of ruxolitinib in ameliorating microvascular dysfunction.