24 y.o. female with h/o 1 month of ongoing nausea/vomiting/diarrhea and weight loss with abdominal pain night sweats and chills. Admitted for evaluation of colitis and UTI found to have thrombocytopenia and anemia.

CT AP study significant for diffuse thickening of the colon, diffuse lymphadenopathy (mesentery, bilateral axillary, mediastinal and hilar pericardiac nodes), splenomegaly and portal edema of liver without acute intra-abdominal findings.

Eventually developed fluid retention and swelling and 20 pounds weight loss.

Histomorphology of the lymph node showed atretic germinal centers with prominent vascular hyperplasia

Histomorphology of the bone marrow showed marrow that is hypocellular for age (50% cellularity) and shows megakaryocytic hyperplasia and dysplasia in the background of diffuse moderate fibrosis.

Clinicopathological findings consistent with TAFRO syndrome (anasarca, pleural effusions, ascites, fevers with elevated CRP, thrombocytopenia, minor criteria of reticulin fibrosis with increased megakaryocytes, organomegaly hepatosplenomegaly and lymphadenopathy, renal insufficiency).