Hydroxyurea Leg Ulcers — RACP Adult Medicine MCQ

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ModerateHaematologyHydroxyurea Leg UlcersRACP Adult Medicine

A 65-year-old man with myeloproliferative neoplasm (PV) on hydroxyurea develops painful leg ulcers on the lateral malleoli bilaterally. He has been on hydroxyurea for 8 years. What is the most likely cause?

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Correct answer: C — Hydroxyurea-induced leg ulcers

Hydroxyurea-induced leg ulcers are a well-recognised adverse effect of long-term hydroxyurea therapy, occurring in up to 10% of patients after prolonged use. They typically occur on the lateral malleoli and are very painful. The mechanism involves endothelial damage and impaired wound healing. Management requires cessation of hydroxyurea and switch to an alternative cytoreductive agent (anagrelide for ET; ruxolitinib for PV/MF; interferon-alpha for PV). Ulcers typically heal slowly over weeks to months after drug cessation. Wound care and pain management are important.

Reference: eTG – 2025 – Haematology; EHA – 2022 – MPN Guidelines