A69-year-oldmanwasadmittedtoourhospitalwithleftupperquadrantpain,splenomegaly,acuterenalfailure,hyperuricemia,thrombocytopenia(plateletcount32,/mm3),andleukocytosis(leukocytecount88,/mm3).Hismedicalhistorywassignificantforpriordiagnosisofmyelodysplasticsyndrome(MDS)bybonemarrowbiopsyatanoutsideinstitutiontreatedwiththehypomethylatingchemotherapeuticagentdecitabine,atrialfibrillation,cardiomyopathy,and
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