A 67 year-old man was admitted to the hospital, because of bone pain and fatigue. The pain presented about six months ago, it was located in the lumbar area and was aggravated by movement. During this period the patient had been administered NSAIDs, but with no effect. The patient was also feeling weak and he reported mild dyspnea on exertion. He, occasionally, was feeling dizzy and experienced visual disturbances. One week before admission he had an episode of epistaxis. His past medical history was not remarkable. On examination, he appeared pale. The temperature was 37.8 °C, the pulse was 100/min and the blood pressure was 140/70 mmHg. The liver was non-tender and palpable 2 cm below the right costal margin. The spleen was not palpable. Pressure on the lumbosacral vertebrae worsened the pain, which had radical features. His hematological tests revealed a normocytic normochromic anemia (Ht: 28.9%, Hb: 9.5 g/dL), a mild leukopenia (WBC: 4,100/μL, neutrophils 21%, lymphocytes 40%, monocytes 10%, metamyelocytes 3% and atypical blast cells 24% [fig. 1]) and platelets 30,000/mL. The erythrocyte sedimentation rate was 135 mm/1 hour. Coagulation studies were normal. His biochemical tests were: BUN 65 mg/dL, creatinine 2.2 mg/dL, SGOT 39 IU/L, SGPT 34 IU/L, LDH 1376 IU/L, ALP 153 IU/L, γ-GT 39 IU/L, Na⁺ 140 mmol/L, K⁺ 4.5 mmol/L, Ca⁺⁺ 6.2 mg/dL, serum total proteins 9.9 g/dL (albumin 4 g/dL, globulins 5.9 g/dL). The serum protein electrophoresis revealed a spike in the area of γ-globulins. The bone marrow aspirate was diagnostic. On the third day of hospitalization the patient's condition worsened. The temperature rose up to 39.3 °C, and he reported a mild pain in the medial area of the right forearm and thigh. The skin of these areas were red and warm. Rapidly the patient's condition deteriorated further, as rigors were added and he became disoriented. The pulse was very weak and the blood pressure was 80/40 mmHg. Antibiotic therapy with a combination of ceftazidime plus amikacin was started. The skin lesions on the forearm (fig. 2) and on the other body areas enlarged and gradually small ulcers containing a greenish smear were formed. The patient's condition improved after 4 days on antibiotic treatment. Blood, as well lesion cultures were positive.