transformation to AML, 11,12 suggesting she may have been at risk for MDS because of her Noonan syndrome. However, given the rareness of this association, the MDS may also be an unrelated sporadic occurrence triggered by the gain of RUNX1, prior eltrombopag therapy, or less likely, an unreported complication of trametinib therapy.Our case demonstrated an unusual presentation of MDS and reminds clinicians of the importance of monitoring for all blood dyscrasias in patients with Noonan syndrome.