Acute myelofibrosis: multifocal bone marrow infiltration detected by scintigraphy and magnetic resonance imaging

Acute myelofibrosis is a rare, malignant hematological disorder of unknown etiology with an inevitably fatal outcome. Here we present the study of a 6 3-year-old Caucasian man with acute onset of pancytopenia. Repeated bone ma rrow biopsies showed dense fibrosis and hypoplastic hematopoiesis raising v arious differential diagnoses of malignant and nonmalignant conditions. Bon e marrow scintigraphy and magnetic resonance imaging (MRI) showed areas sug gesting neoplastic infiltration, mainly in both femurs and tibias. Histolog ical examination of a surgical biopsy of the left tibia revealed acute mega karyoblastic leukemia. As the patient refused polychemotherapy, therapy wit h interferon gamma was initiated but discontinued prematurely because of in tolerable side effects. The presented case therefore suggests that the comb ination of bone marrow scintigraphy and MRI is a valuable diagnostic tool i n patients presenting with myelofibrosis of unknown origin.