case_images: PMC11150609_01
case_images: (A) Magnetic resonance imaging documenting active sacroiliitis; (B) lower limb purpuric lesions; (C) ear chondritis.
case_images: fimmu-15-1403808-g002.jpg
case_images: PMC11150609_01_fimmu-15-1403808-g002.jpg
case_images: f2
case_images: MCV 105.7 fL, CRP 0.58 mg/dL, ESR 115 mm/h). Magnetic resonance imaging (MRI) of the sacroiliac joints was obtained and showed bilateral sacroiliitis with moderate asymmetric inflammatory activity (see  Figure 2 ). On admission, he presented with inflammatory lower back pain, bilateral lower limb purpuric skin lesions (see  Figure 2 ), worsening anemia (Hb 8.5 g/dL, MCV 100.0 fL), and raised CRP and ESR (10.5 mg/dL and 88 mm/h, respectively). On the third week of hospital admission with persistent fever, slightly improved inflammatory lower back pain, and persistently elevated acute-phase reactants, the patient developed auricular chondritis (see  Figure 2 ).
case_images: Bone marrow with vacuolization of myeloid and erythroid precursor cells.
case_images: fimmu-15-1403808-g003.jpg
case_images: PMC11150609_01_fimmu-15-1403808-g003.jpg
case_images: f3
case_images: Due to the persistence of disproportionate macrocytic anemia after discharge, a review of the bone marrow aspirate was requested, showing extensive vacuolization of myeloid and erythroid precursors, without features of MDS (see  Figure 3 ).