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Clinically amyopathic dermatomyositis usually presents with severe skin rashes but no muscle involvement and is associated with the highly lethal form of rapidly progressive interstitial lung disease. Diagnosis of myositis-related acute interstitial pneumonia can be particularly challenging, as the clinical presentation of hypoxia and respiratory failure has a broad differential diagnosis. This is especially true when the characteristic skin or muscle finding are absent and the patient has no history of idiopathic inflammatory myopathies. We present a rare case of a patient who presented with rapidly worsening acute respiratory failure from acute interstitial pneumonia due to an undiagnosed amyopathic dermatomyositis with positive anti-MDA5 autoantibody without any of the typical myositis symptoms or physical exam findings., (Copyright © 2022 Baylor University Medical Center.)

We report a 35-year-old healthy male who developed central nervous system inflammatory demyelinating disease consistent with tumefactive multiple sclerosis. About 2 weeks after onset of symptoms and prior to initiation of therapy, the patient had lymphopenia and low CD4 and CD8 levels. His lymphocyte count was 400 cells/µl (850-3,900 cells/µl), CD4 was 193 cells/µl (490-1,740 cells/µl) and CD8 was 103 cells/µl (180-1,170 cells/µl). He was treated with intravenous methylprednisolone followed by therapeutic plasma exchange, the levels of CD4 and CD8 normalized, and ultimately, he recovered completely.

Gelatinous bone marrow transformation (GMT), also known as starvation marrow, represents a rare pathological entity of unclear etiology, in which bone marrow histopathology demonstrates hypoplasia, fat atrophy, and gelatinous infiltration. The finding of gelatinous marrow transformation lacks disease specificity; rather, it is an indicator of severe illness and a marker of poor nutritional status, found in patients with eating disorders, acute febrile illnesses, acquired immunodeficiency syndrome, alcoholism, malignancies, and congestive heart failure. We present a middle-aged woman with a history of alcoholism, depression, and anorexia nervosa who presented with failure to thrive and macrocytic anemia, with bone marrow examination demonstrative of gelatinous transformation, all of which resolved with appropriate treatment. To our knowledge, there are very few cases of GMT which have been successfully treated; thus, our case highlights the importance of proper supportive management.