CASE HISTORYThe patient is an 81-year-old gentleman who was referred to the hematology/oncology service for worsening fatigue and skin lesions. His past medical history is significant for myelodysplastic syndrome diagnosed 5 months ago. He was symptomatically treated and followed a relatively stable course until approximately 1 month ago. At that time, he noticed multiple skin lesions over his trunk and legs, and also became increasingly fatigued with exertional dyspnea, finding himself short of breath after climbing one flight of stairs. Laboratory data were significant for 30% circulating blasts, neutropenia (ANC ¼ 0.96/mm 3 ), macrocytic anemia (Hgb 7.7 g/dL, MCV 109.6), and thrombocytopenia (52 Â