A 66-year-old woman of mixed white, African, and Native American descent with refractory AML developed darkening of her skin during treatment with eltrombopag. She had received cytarabine and daunorubicin 3 months prior to initiating a clinical trial with eltrombopag. Two months after starting eltrombopag therapy, the dermatology consult team was called to evaluate subcutaneous nodules clinically suggestive of Sweet syndrome. At that time she was noted to have a diffuse dusky complexion involving her face, arms, and legs. A biopsy of a subcutaneous nodule on her leg was performed. In addition to deep neutrophilic inflammation, there was prominent pigment deposition in the mid to deep dermis staining positive with both Fontana-Masson and Prussian blue stains (Figure 2). The pigmentation remained stable 3 months into eltrombopag therapy. The patient, her husband, and the oncology team believed that she was notably darker than before beginning eltrombopag treatment, and on comparison with a family photograph, the patient’s skin was believed to be darker than baseline by the dermatology team.