case_images: PMC9695688_01
case_images: PMC9695688_02
case_images: A) frontal bossing; ultrasonography image showing; B) hepatomegaly; C) splenomegaly
case_images: PAMJ-43-30-g001.jpg
case_images: PMC9695688_02_PAMJ-43-30-g001.jpg
case_images: F1
case_images: Head and neck examination revealed frontal bossing depressed nasal bridge (Figure 1 A). Abdominal ultrasonography (US) revealed hepatosplenomegaly (liver span: 8.7cm, spleen span: 10.3cm), and other abdominal organs were within a normal appearance (Figure 1 B, C).
case_images: A) lateral skull radiograph showing increased thickness of skull base (arrow); B) increased bone density with little differentiation between cortex and medulla in long bone and pelvis (yellow arrows), metaphyseal modeling defects, and characteristic lucent bands (red arrow)
case_images: PAMJ-43-30-g002.jpg
case_images: PMC9695688_02_PAMJ-43-30-g002.jpg
case_images: F2
case_images: bone marrow aspiration showing A) dry tap and hypocellularity of all cell lines; B) myelosclerosis with no cellular fragments (arrow); C) no hematopoietic cells with increased fat cells (arrow)
case_images: PAMJ-43-30-g003.jpg
case_images: PMC9695688_02_PAMJ-43-30-g003.jpg
case_images: F3
case_images: Bone marrow aspiration (BMA) shows dry tap and hypocellularity of all cell lines (Figure 3). Brain magnetic resonance imaging (MRI) shows mild dilated cerebral ventricles with no midline shift or deformities.
case_images: brain magnetic resonance imaging showing A) mild dilated third ventricle (arrow); B) prominent cortical sulci and sylvan fissures (arrow)
case_images: PAMJ-43-30-g004.jpg
case_images: PMC9695688_02_PAMJ-43-30-g004.jpg
case_images: F4
case_images: All these findings were suggestive of brain atrophy (Figure 4).