LEGENDS
Figure 1 Timeline of events from initiation of chemotherapy treatment to time of publication
#1 Course 1 induction chemotherapy (MEC) with mitoxantrone 25mg/m2, etoposide 750mg/m2 and cytarabine 2800mg/m2 administered.
#2 Course 2 induction chemotherapy (ADxE) with cytarabine 1400mg/m2, daunorubicin 180mg/m2 and etoposide 450mg/m2 administered.
1 Day 29 marrow confirmed remission status with MRD<0.1%
2 Day 40 marrow before course 2 induction chemotherapy continued in remission with MRD<0.1%
3 Bone marrow aspirate performed 2 weeks after completion of 1 course of low dose bridging chemotherapy (prior to consideration of starting consolidation chemotherapy) confirmed persistent remission status with MRD<0.1%
4 Regular 4-weekly bone marrow aspirate confirmed remission with MRD<0.1%
5 Regular 4-weekly bone marrow aspirate confirmed remission with MRD<0.1%
1 MRI of right lower limb revealed bilateral shotty groin lymph nodes, largest 1.6cm at right groin and 1cm at right popliteal fossa, accompanied with subcutaneous edema over right upper medial and posterior distal thigh (Fig. 1A) . Neutrophil and monocyte counts were all along less than 1 x 109/L and 0.2x109/L respectively.
2 MRI of groins and right ankle showed abscess at right groin and lateral aspect of right ankle with underlying osteomyelitis of calcaneus(Fig 1B) .
3 MRI of bilateral lower limbs showing interval improvement in inflammatory changes over bilateral femur, tibia and right calcaneus
4 MRI of hips showing mild synovitis
5 MRI of right ankle showed minimal residual inflammatory changes at right calcaneus
Bx USG-guided aspiration and biopsy were performed, which yielded granulomas with surrounding suppurative inflammation (Fig. 1C) . A moderate number of AFB were highlighted on aspirate sample. Neutrophil and monocyte counts recovered.
1 PET-CT showed abscesses in right posterior thigh and popliteal fossa (SUVmax 3.8), right calcaneal osteomyelitis (SUVmax 9.4), as well as multiple hypermetabolic LN at right groin (SUVmax 6.5) extending to right internal iliac LN (Fig. 1D) .
2 PET-CT showed worsening of right calcaneal osteomyelitis with increased bony lysis
3 PET-CT showed residual infective focus at right calcaneus with interval reduction in metabolic activity over right groin and right popliteal fossa.
4 PET-CT showed resolution of right groin lymphadenopathy and right popliteal fossa subcutaneous lesion, also decreased metabolic activity at right calcaneus.
§1 First operation on calcaneal bone excision and debridement of right ankle
§2 Second operation involving I&D of right groin and popliteal abscesses along with debridement of right ankle soft tissue
§3 Third operation on sequestrectomy of right calcaneus and insertion of antibiotic-infused cement (vancomycin, amikacin and gentamycin)
§4 Fourth operation on removal of antibiotic-infused cement and bone graft insertion
Figure 2 (A) MRI of bilateral hips and thigh showing bilateral shotty groin LN accompanied with subcutaneous edema over right upper medial thigh and posterior distal thigh (B) MRI of right ankle showing T1 hypointense and T2 hyperintense signals at right talus, right distal tibia, right third proximal metatarsal, right distal fibula, right calcaneus and right posterior ankle. (C) Suppurative aspirate obtained by ultrasound-guided aspiration of right groin abscess (D) PET-CT 12 days after first operation showing abscesses in right posterior thigh and popliteal fossa (SUVmax 3.8), right calcaneal osteomyelitis (SUVmax 9.4), as well as multiple hypermetabolic LN at right groin (SUVmax 6.5) extending to right internal iliac LN