The bone marrow biopsy demonstrated significant granulocytic hyperplasia, megakaryocytic atypia and increased CD34-positive cells with persistent t(9;15) involving PML. She had stable blood counts and a good performance status until approximately two years later, when she developed painful ulcerations of toes, thought to be an atypical presentation of sclerodermoid graft versus host disease (GVHD) complicated by underlying Raynaud’s disease and treated successfully with ruxolitinib. Here, PML is linked to graft versus host disease.