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Can aplastic anemia present with multiple infiltrative bone lesions, such as in the spine and pelvis?

An adolescent male presented with blurry vision and was found to have papilledema. MRI of the brain and spine showed numerous infiltrative bony lesions throughout the spine and pelvis. CBC showed severe pancytopenia, and 3 bone marrow aspirations/biopsies, including 1 iliac spine and an S1 spinal body biopsy, were all negative for malignancy. The full bone marrow failure panel and MDS panel from PB and BM are pending.
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Pediatric Hematology/Oncology · St Jude Children's Research Hospital
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There are several studies showing diffuse hypointense pictures with an infiltrative-like pattern on MRI in aplastic anemia and MDS. Some aplastic anemia and refractory cytopenia of childhood show patchy pattern of hematopoiesis with some regions having increased fat fraction and some remnants of hem...

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Hematology · Dana-Farber Cancer Institute
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It is exceedingly unlikely that such bone lesions are due to aplastic anemia. AA is the absence of hematopoiesis, so there is no mechanism for bone lesions to be present.

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Pediatric Hematology/Oncology · University of Florida
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I have seen a similar presentation in a child with severe myelosclerosis that appeared as infiltrating bone lesions with pancytopenia, as well as in megakaryocytic leukemia that can present as pancytopenia for a while before abnormal blasts are identified. I am sure that bone marrow biopsy/sometimes...

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