#00064027

63-year-old women with history of hypertension, chronic kidney disease, Sjogren’s syndrome, who presented with symptomatic moderate, normocytic, normochromic anemia (hemoglobin of 9). Her iron, vitamin B12, folate and erythropoietin levels are within normal limit.

Bone marrow core biopsy by H-E stain shows normocellular bone marrow with progressive maturation in a background of multifocal panniculitis (panels A and B; original magnification X100 and X400 respectively). CD68 immunohistochemistry highlights lipid laden macrophages (panel C, original magnification X400). Prussian blue staining shows golden brown lipofuscin pigment in addition to blue iron (panel D, original magnification X1000). Bone marrow aspirate smears show morphological normal myeloid and erythroid maturation pattern. Flow cytometry, chromosomal analysis, MDS FISH panel, NGS MDS panels are all within normal limit.

Sjögren's syndrome is a chronic autoimmune disease, often associated with other rheumatologic conditions, which targets the moisture-producing glands and mucosa of mouth and eyes, resulting in dry eyes and mouth. By literature search few case reports of panniculitis involving subcutaneous fat and mesentery associated with Sjogren syndrome were found. But there is no mention about bone marrow panniculitis in the literature. The bone marrow panniculitis could be a cause of anemia commonly seen in Sjogren’s syndrome.