Extensive necrosis affecting more than 50% of the bone marrow is an extremely rare histopathological finding.Relatively little is known about its clinical significance because it is most commonly identified at autopsy - whether it is an independent prognostic c6 corvette door handle marker or whether it is a surrogate marker of underlying disease burden remains unclear.We describe herein a case of a 66-year-old patient with acute myeloid leukemia who presented with acute bone marrow failure and was found to have extensive necrosis.We include presenting clinical features, pathology attained at biopsy, and the challenge of whole wheat phyllo dough treatment.Bone marrow necrosis is a rare but important clinicopathological entity whose recognition may herald the way for more effective prognostication of underlying disease.