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Bone marrow biopsy showing increased reticulin fibrosis: hematoxylin and eosin (H&E) ×100 (A), H&E ×200 (B), and reticulin ×200 (C). Peripheral blood smear showing anisopoikilocytosis and occasional teardrop cells (D).

Double Jeopardy: Autoimmune Myelofibrosis with Pyoderma Gangrenosum

A 33-year-old African American woman with no significant past medical history presented to an outside hospital with 3 months of oropharyngeal ulcers and odynophagia. She was also noted to be pancytopenic (hemoglobin 7.4 g/dL, mean corpuscular volume 81 fL, platelets 100,000/mm3, white blood cells 3000/mm3, absolute neutrophil count 600/mm3) with blood smear findings of teardrop […]

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Clinical manifestations of the left lower extremity, and X-ray and computed tomography images of the chest. (A) Painful deep ulcers with necrotic tissue and diffuse erosive purpura. (B) A butterfly shadow indicating pulmonary edema. (C) Ground-glass opacity and infiltrative shadows around bilateral hilar regions, thickening of interlobular septa, and bilateral pleural effusions are observed. (D) After methylprednisolone pulse treatment, the ulcers expanded with massive necrotic tissue. (E) After 11 months of treatment the ulcers have fully healed, with distinguishable scars reaching the muscles.

Pyoderma Gangrenosum Associated with Acute Respiratory Distress Syndrome

To the Editor: Pyoderma gangrenosum is a rare neutrophilic dermatologic disorder that presents as painful necrotic ulcers. It can also involve the lungs and the kidneys. The etiology remains unclear. However, it has recently been reported that cytokines may play a key role in pyoderma gangrenosum’s pathogenesis. Similarly, acute respiratory distress syndrome is characterized as lethal […]

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