Severe neurofibromatosis type 1 is shown in a 45-year-old woman who was admitted for a severe exacerbation of asthma. Inguinal freckling (known as Crowe's sign), cafe au lait macules (straight arrows), and neurofibromas (curved arrows) are present. The cafe au lait macules were noted at birth; the neurofibromas began to appear during puberty. Philip R. Cohen, M.D. University of Texas Medical School, Houston, TX 77030 Source: nejm.org