Given the elevation of VEGF and lack of clinical response to IVIG, bone marrow biopsy was completed on hospital Day 12 which revealed a plasma cell neoplasm with mild atypia involving 6% of the sample in aspirate smear (Figure 1(a)) and 3% on cyclin D1 immunostaining (Figure 1(b)). The gene discussed is VEGFA; the disease is plasma cell neoplasm.