Presented is a patient with dyspnea and painful ulcers finally resulting in multi-organ failure. A detailed history resulted in positive PCR testing for Chlamydia psittaci. We emphasize the importance of a definitive history in establishing the correct diagnosis. When clinicians observe dyspnea with multiorgan failure, they should be aware of psittacosis.

Anti-tumour necrosis factor-α (TNFα) agents are effective in diseases including Crohn's disease but may cause cytopenias. The mechanisms involved in anti-TNFα agent-induced thrombocytopenia are scarce. We report a 73-year-old male with Crohn's disease for which he currently used adalimumab, an anti-TNFα agent. He had received mesalazine and infliximab before the treatment of adalimumab. No comorbidities were present. Routine laboratory tests revealed a deep thrombocytopenia (thrombocytes 24 × 10 9 /L), after which adalimumab was discontinued. Bleeding symptoms included cutaneous haematomas and mild epistaxis. Direct monoclonal antibody-specific immobilization of platelet antigens revealed autoantibodies specific to glycoprotein IIb/IIIa and glycoprotein V platelet receptors. There was no bone marrow suppression. Other causes of the thrombocytopenia were ruled out. The platelet count normalized after adalimumab discontinuation. No further interventions were required. Monitoring thrombocyte levels after initiating anti-TNFα agents is recommended, which could lead to prevention of this potentially fatal phenomenon.

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A 35-year-old man with a history of ankylosing spondylitis for which he received adalimumab was referred to our clinic because of marked leukocytosis detected from a routine blood test. He experienced occasional night sweats. He was found to have splenomegaly. The complete blood count showed normocytic anemia (13.37 g/dL, 90 fL), normal platelets (315 3 10 9 /L), and leukocytosis (32.8 3 10 9 /L) with basophilia (51%), eosinophilia (20%), promyelocytes (1%), and blasts (1%). Peripheral blood smear revealed prominent basophilia and atypical eosinophilia (panel A, atypical basophilic granulocytes; panel B, atypical eosinophilic granulocytes, with clearly visible cytoplasm, prominent nuclei, and an increased nuclear-cytoplasmic ratio; original magnification 3100, May-Grünwald Giemsa stain).Immunophenotyping showed a cell population negative for CD117, CD2, and CD25. Bone marrow biopsy showed increased cellularity with ,10% myeloblasts as well as marked reticulin fibrosis. BCR-ABL1 fusion was negative. Conventional cytogenetics with gene-specific probes showed an extremely rare t(9;12)(q34;p13) resulting in the ETV6-ABL1 fusion. No additional cytogenetic abnormalities were observed, including no PDGFRa rearrangements.The ETV6-ABL1 fusion induces a chronic myeloid leukemia-like disease with a more aggressive behavior and prominent basophilia. The patient received dasatinib with complete molecular response followed by an allogeneic transplantation.For additional images, visit the ASH Image Bank, a reference and teaching tool that is continually updated with new atlas and case study images. For more information, visit http://imagebank.hematology.org.