The patient is a 44-year-old inmate with a 3-month history of unexplained pancytopenia. Prior medical history is significant for treated bipolar disorder and a substance use disorder involving synthetic cannabinoids ("K2"), along with paper soaked with pyrethroid containing pesticides ("KD"), since his arrival at a new facility 3 months ago.Laboratory studies showed a white cell count of 460/µl (reference range: 4200-10,700/µl), a hemoglobin level of 10.5 g/dl (reference range: 13.5-17.5 g/dl), and a platelet count of 28,000/µl (referenceE 1 Promyelocytes containing numerous large rhomboid and smaller irregular shaped cytoplasmic immature pink azurophilic crystals (Wright-Giemsa stain, original magnification 1000×) forming clumps with cytoplasmic clearing Authors Vasily Ovechko and Matthew G. Bayes contributed equally to this work.
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