Given the under-recognition of VEXAS in Asian populations and the expanding spectrum of pathogenic UBA1 variants, clinicians should consider somatic sequencing in elderly men with refractory neutrophilic dermatoses—even in the absence of classical hematologic abnormalities, including macrocytic anemia, thrombocytopenia, and vacuolization of myeloid and erythroid precursors in the bone marrow. The gene discussed is UBA1; the disease is macrocytic anemia.