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Tan and Zipursky describe a patient with new diagnosed AML who, after the administration of IV contrast, develops a cutaneous reaction in association with a neutrophil leukocytosis. Although acute generalized exanthematous pustulosis may present with a reactive neutrophilia, this peripheral blood manifestation would be very surprising and rare in a patient with active AML, where marrow failure (including neutropenia) and circulating blast cells are more typical findings. Moreover, a reactive eosinophilia would be difficult to achieve unless eosinophils were either part of the malignant clone or a paraneoplastic phenomenon. Overall, in patients with myeloid malignancies with pathognomonic features of disordered hematopoiesis, traditional "reactive" or secondary findings in the peripheral blood are not reliable.