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Myelodysplastic syndrome (MDS) usually presents with cytopenias  because of bone marrow failure. Solid organ infarcts in myelodysplastic syndrome (MDS) is rarest complication. We report an elderly male, admitted with complaints of pain abdomen mainly in both flanks and swelling all over the body. Peripheral  blood smear, bone marrow aspirate for cytology were suggestive of myelodysplastic syndrome(MDS) with refractory anaemia. Fluorescence in situ hybridization(FISH) were negative for any chromosomal abnormalities. His CECT abdomen was done which revealed hepatosplenomegaly with hyperdense liver with multiple splenic and renal infarcts and patient was treated as a case of MDS with refractory anaemia with solid organ infarcts. Over a period of 3 days, he had Acute Kidney Injury (AKI).  Patient succumbed on fifth day.

Embolia cutis medicamentosa is a rare complication of intramuscular injury that leads to varying degrees of necrosis of the skin and subcutaneous tissue. In 1924, embolia cutis medicamentosa or Nicolau syndrome (NS) was first portrayed after an intragluteal injection of bismuth salts was given for the treatment of syphilis but it has now been documented with several drugs. (Murthy et al., 2007)1. According to one hypothesis, embolia cutis medicamentosa occurs when an intramuscular drug is accidentally injected into the arterial lumen or wall, leading to vessel thrombosis, subcutaneous tissue and muscle necrosis (Senel et al., 2010)2. Necrosis develops after hyperemia, skin discoloration usually associated with severe pain and wide inflammatory livedoid dermatitis and haemorrhagic patch at the injection site (Hamilton et al., 2008)3. Severe cases may take an immediate clinical course and anticipate to death.

Wilson’s disease (WD) is a genetic disorder characterised by mutations in copper metabolism. Adenosine triphosphate (ATPase) ATP7B gene is responsible for disturbance in copper metabolism that leads to accumulation of copper mainly in liver and also in extra hepatic organs (like brain, cornea, heart and kidney).1 Heavy metal accumulation in brain (mainly in basal ganglia) leads to neuropsychiatric manifestations.2 Kayser Fleischer (KF) ring is golden brown ring distributed along the periphery of cornea. It is due to abnormal deposition of copper in the Descemet’s membrane of cornea. Kayser Fleischer (KF) ring is a pathognomonic sign of Wilson’s disease. Fulminant hepatic failure can be the first presentation of WD. Patients presenting with fulminant Wilson’s disease (FWD) clinically present as acute liver failure with encephalopathy and coagulopathy. The mortality of patients is high and orthotropic liver transplantation is the only option, which has been shown effective in patients with Fulminant Wilson’s disease.3 We are report a case of a young male who presented as acute liver failure first time in life and later was diagnosed as FWD.