The presence of vacuoles in the cytoplasm and in the nuclei of the cells of blood forming tissues has been long recognized as a feature of disturbed hematopoiesis. It is common to a variety of pathologic conditions. It has been encountered in association with administration of chloramphenicol,1-4 with prolonged antimetabolite therapy,5 in riboflavin deficiency,6 in phenylalanine deficiency,7,8 in acute and chronic alcoholism,9,10 in septicemia,11 and in erythroleukemia (Di Guglielmo syndrome).12
Recently, marked vacuolization of the bone marrow cells was noted in a severely ill patient with septicemia who was treated with large doses of chloramphenicol. Chromosomes obtained from the marrow also contained vacuoles and some, in addition, showed multiple breakages of the chromatids.
A 66-year-old retired male was admitted to the New England Medical Center Hospitals on Jan 20, 1967, with a four day history of abdominal pain and "collapse." Diagnosis