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Bilateral pulmonary uptake in an asymptomatic patient with normal chest X-rays and a monoclonal gammopathy is described. At the 11-month follow-up the patient is asymptomatic and chest X-ray remains normal.

TO THE EDITOR.— The article by Murray et al on staphylococcal septicemia in association with disseminated intravascular coagulation (DIC), which appeared in the July Archives (137:844-847, 1977), prompted us to report on the case of one of our patients who had a similar problem. REPORT OF A CASE.— A 46-year-old man, who was receiving combination chemotherapy for histiocytic leukemia, was admitted to the hospital June 17, 1977, with symptoms suggestive of gastritis. His vital signs were normal, and there were no important physical findings except for pallor. Laboratory data were unremarkable other than marked anemia, for which he was given packed RBCs. He developed a temperature of 38.3 C and chills on June 24. Blood cultures grew Staphylococcus aureus, and he was given nafcillin sodium and gentamicin sulfate. On June 27, multiple purpuric lesions were noted on the trunk and extremities, and subconjunctival hemorrhages developed. Three days later, a holosystolic murmur

TO THE EDITOR. —Sickle cell dactylitis is a well-known clinical and roentgenologic entity. It has been described in homozygous sickle hemoglobinopathy, sickle cell C disease, and sickle-β thalassemia.1,2 To our knowledge, this complication of sickle cell disease has not been reported in patients above the age of 10 years. We report the case of an adult with sickle-β thalassemia in whom dactylitis of both hands developed. REPORT OF A CASE. —A 26-year-old black man had been observed for sickle-β thalassemia. Past history included four to five pain crises each year since childhood. There was no history of the hand-and-foot syndrome as a child. The patient was admitted to Cook County Hospital, Chicago, for sudden onset of fever and diffuse swelling of both hands of five days' duration. Physical examination showed a young man in moderate distress from pain, with temperature of 38.3 °C. He had jaundice; the spleen was