Gelatinous transformation of bone marrow in systemic lupus erythematosus

Gelatinous transformation is characterized by disruption of normal architecture of bone marrow in that the marrow cells arrange themselves in long cords, small clusters, and singly; and fat cells are partially replaced by a fibrillary substance which stains positive with Alcian Blue alone but negative with Alcian Slue if pre-treated by hyaluronidase. Gelatinous transformation of marrow is a rare entity described in cachexia, anorexia nervosa, and myxedema. Its association with systemic lupus erythematosus has never been reported. We found this condition in 3 out of 30 lupus patients with pancytopenia. Two of the patients were cachetic, one of whom also had active tuberculosis. We propose that gelatinous transformation of marrow can be associated with systemic lupus, and that its detection in lupus patients calls for an evaluation of nutritional status, and a search for chronic debilitating infections such as tuberculosis.