{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:36:05Z","timestamp":1787016965659,"version":"build-2736575974"},"reference-count":18,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2016,12,3]]},"abstract":"<jats:p>A 35-year-old man with a 12-year history of idiopathic myelofibrosis (IMF) presented in 2014 with fatigue and abdominal distension. CT scan revealed massive hepatosplenomegaly with focal splenic lesions, soft tissue around renal pelvis, mesenteric masses compressing bowel loops and perilymphatic nodules in lungs. There was portal hypertension, ascites, pleural effusion, bilateral psoas abscesses and necrotic retroperitoneal lymphadenopathy. MRI additionally revealed hypointense periportal infiltrative lesions in liver, not seen on CT scan. None of these lesions showed diffusion restriction. Biopsy from mesenteric masses revealed extramedullary haematopoeisis. Aspiration from psoas abscess confirmed tuberculosis. Follow-up after 6\u2005weeks of ruxolitinib (JAK2 tyrosine kinase inhibitor) and 9\u2005months of antitubercular therapy revealed resolution of psoas abscesses and lymph nodes. Mild reduction was noted in mesenteric masses and ascites while perirenal soft tissue had increased. Follow-up imaging after another 1\u2005year of ruloxitinib showed new-onset bilateral paravertebral and presacral foci of extramedullary haematopoeisis.<\/jats:p>","DOI":"10.1136\/bcr-2016-217854","type":"journal-article","created":{"date-parts":[[2016,12,24]],"date-time":"2016-12-24T14:27:28Z","timestamp":1482589648000},"page":"bcr2016217854","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Idiopathic myelofibrosis with disseminated hepatosplenic, mesenteric, renal and pulmonary extramedullary haematopoeisis, portal hypertension and tuberculosis: initial presentation and 2\u2005years follow-up"],"prefix":"10.1136","volume":"2016","author":[{"given":"Ananya","family":"Panda","sequence":"first","affiliation":[{"name":"All India Institute of Medical Science, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheragaru Hanumanthappa","family":"Chandrashekhara","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aruna","family":"Nambirajan","sequence":"additional","affiliation":[{"name":"Department of Pathology, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pravas","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Hematology, All India Institute of Medical Science, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,12,23]]},"reference":[{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2311020673"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.2","doi-asserted-by":"publisher","DOI":"10.1007\/s12032-008-9099-2"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.3","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.179.5.1791239"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.4","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-011-1323-z"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.5","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2453040715"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.6","doi-asserted-by":"crossref","first-page":"460","DOI":"10.3346\/jkms.2000.15.4.460","article-title":"CT findings of extramedullary hematopoiesis in the thorax, liver and kidneys, in a patient with idiopathic myelofibrosis","volume":"15","author":"Kwak","year":"2000","journal-title":"J Korean Med Sci"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.7","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1159\/000057636","article-title":"Idiopathic myelofibrosis with nodal, serosal and parenchymatous infiltration. Case report and review of the literature","volume":"107","author":"Tzankov","year":"2002","journal-title":"Acta Haematol"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.8","doi-asserted-by":"crossref","first-page":"401","DOI":"10.3348\/jksr.2009.61.6.401","article-title":"Periportal extramedullary hematopoiesis","volume":"61","author":"Ha","year":"2009","journal-title":"J Korean Soc Radiol"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.9","first-page":"1","article-title":"CT and MR findings in extramedullary haematopoiesis with biliary system encasement: a case report","volume":"4","author":"La Fianza","year":"2010","journal-title":"J Radiol Case Rep"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.10","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1259\/bjr.72.861.10645201","article-title":"Imaging features of focal intrahepatic extramedullary haematopoiesis","volume":"72","author":"Wong","year":"1999","journal-title":"Br J Radiol"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.11","doi-asserted-by":"crossref","first-page":"507","DOI":"10.2214\/AJR.04.1788","article-title":"Diffuse mesenteric extramedullary hematopoiesis with ascites: sonography, CT, and MRI findings","volume":"186","author":"Holden","year":"2006","journal-title":"AJR Am J Roentgenol"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.12","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/0016-5085(87)90984-X","article-title":"Agnogenic myeloid metaplasia, portal hypertension, and sinusoidal abnormalities","volume":"92","author":"Roux","year":"1987","journal-title":"Gastroenterology"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.13","doi-asserted-by":"crossref","first-page":"3128","DOI":"10.3748\/wjg.15.3128","article-title":"Portal hypertension secondary to myelofibrosis with myeloid metaplasia: a study of 13 cases","volume":"15","author":"Abu-Hilal","year":"2009","journal-title":"World J Gastroenterol"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.14","doi-asserted-by":"publisher","DOI":"10.1007\/s003300050850"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.15","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/0002-9343(91)90513-W","article-title":"Ascites revealing peritoneal and hepatic extramedullary hematopoiesis with peliosis in agnogenic myeloid metaplasia: case report and review of the literature","volume":"90","author":"Liot\u00e9","year":"1991","journal-title":"Am J Med"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.16","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1002\/ccr3.268","article-title":"Nontuberculous mycobacterial infection in a patient with myelofibrosis: case report and concise review","volume":"3","author":"Henriquez-Camacho","year":"2015","journal-title":"Clin Case Rep"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.17","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2014.115840"},{"key":"2025082800434467000_2016.dec23_1.bcr2016217854.18","doi-asserted-by":"publisher","DOI":"10.2217\/fon.14.272"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-217854","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:43:55Z","timestamp":1756367035000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-217854"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,12,23]]},"references-count":18,"alternative-id":["10.1136\/bcr-2016-217854"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-217854","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,12,23]]}}}