Bone marrow necrosis in an adult patient with precursor B-cell acute lymphoblastic leukaemia at the time of presentation.

A 58-year-old Kurdish woman with a history of diabetes, presented to our clinic with fever and rigour for 2 week's duration, associated with diffuse bone pain and weight loss. Laboratory work showed pancytopenia with haemoglobin 107 g/L, white cell count 3.3×109/L (absolute neutrophil count 1.5×109/L) and platelet count 8×109/L, lactate dehydrogenase was 1227 U/L and uric acid 8 mg/dL. The blood film showed normochromic normocytic anaemia with rouleaux formation. A bone marrow aspiration was diluted and looked like an artefact, no megakaryocytes detected, the blasts account for 40% on the available cells, and they were of acute lymphoblastic leukaemia (French-American-British (FAB)–L2; figure 1). The bone marrow biopsy revealed diffuse necrosis, cells loosing normal staining with …