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“1 SPTLC1 Introduction With the increasing use of agents that block the action of tumor necrosis factor (TNF)-α in the treatment of rheumatoid arthritis (RA) and other chronic immune-mediated inflammatory conditions, recognition of serious adverse events assumes greater importance even when they are rare [1]. We report a patient with RA who presented with transient bone marrow (BM) aplasia associated with the first injection of etanercept, and review the literature on TNF-blocking agent-associated cytopenias. 2 Report of a Case A 62-year-old woman was admitted with fatigue, fever (39 °C), gingival PF-3084014 supplier bleeding, and a rash over her legs. She had a history of RA diagnosed 6 years prior when marked synovitis in more than ten large and small joints was found, associated with prolonged morning stiffness, elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and strongly positive rheumatoid factor and anti-citrullinated peptide antibodies (250 IU/ml and 76.6, respectively). Her recent treatment included methotrexate (22.