To the Editor.
—Bone marrow necrosis, which has been described in sickle cell disease, infectious diseases, and cancer,1-6 is a disorder rarely diagnosed during life. In the November 1982 Archives (1982;142:2223-2225), Pardoll et al reported a case of bone marrow necrosis associated with sickle cell disease. Reticuloendothelial scans showed widespread abnormalities consistent with marrow infarction; widespread microvascular obstruction by masses of sickle cells seems plausible as a mechanism of marrow necrosis.5 Nevertheless, the bone marrow necrosis pathogenesis is unknown in neoplasia and infectious diseases. We report a case of bone marrow necrosis diagnosed antemortem in a patient with gastric metastatic adenocarcinoma, where postmortem pathologic studies may bring further knowledge about necrosis physiopathology.
Report of a Case.
—A 60-year-old man was admitted to the hospital after three weeks of fever, dyspnea, and bone pain in the lower part of the back. Physical examination showed a severely ill patient, pale with petechia on the limbs, and necrosis in his right toes.