PMC6334338_01
Bone marrow eosinophilia. A representative Wright-Giemsa stain, (x400) of bone marrow aspirate smears from case 1. Notice the presence of various immature eosinophils, including eosinophilic band and Polymorphonuclear eosinophils (A), as well as eosinophilic myelocyte and eosinophilic metamyelocyte (B).
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F1
The percentage of blast cells in the BM was 2.4% with trilineage dysplasia seen in megakaryocytes, as well as in myeloid and erythroid lineages (Figures 1A,B).
Chromosomal analysis of case 1. A representative metaphase chromosomal analysis of the bone marrow cells derived from case 1. Arrows indicate the allelic imbalance of trisomy 1q and monosomy 7q.
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F2
Chromosomal analysis of BM cells showed 46, XY, +1, der(1;7) (q10;p10) in 13 of 20 metaphases (Figure 2).
The clinical course of case 1. The X axis indicate the time (days). AZA, azacitidine; WBC, white blood cells; PLS, prednisolone.
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F3
The patient was treated with 75 mg/m2 azacitidine (AZA) once daily for five consecutive days on a 28-day cycle based (Figure 3).
Representative chest computer tomography of case 1, showing consolidation in the right lower lung field at day 60 and consolidation in the left lower lung field at day 120.
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F4
However, before starting the third cycle of AZA, dyspnea, cough and wheezing significantly worsened and a new infiltrate was detected in the left lower lung field (Figure 4).
PMC6334338_02
Chromosomal analysis of case 2. A representative metaphase chromosomal analysis of the bone marrow cells derived from case 2. Arrows indicate the allelic imbalance of trisomy 1q and monosomy 7q.
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F5
Chromosomal analysis of BM cells showed 46, XY, +1, der(1;7) (q10;p10) in 4 of 20 metaphases (Figure 5).
The clinical course of case 2. The X axis indicate the time (days). WBC, white blood cells; PLS, prednisolone.
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F6
However, the maculopapular rash and eosinophilia reoccurred along with tapering the methylprednisolone to 25 mg/day along with a rapid and progressive increase in the serum levels of creatinine (7.61 mg/dl) (Table 2 and Figure 6).
Representative images of periodic acid methenamine silver staining (high magnification) of renal specimen from patient 2 showing duplication of the capillary wall consistent with membranoproliferative glomerulonephritis.
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F7
Mesangial interposition neither endocapillary hypercellularity nor crescent formation in these glomeruli were noted periodic acid methenamine silver staining revealed duplication of the capillary wall (Figure 7).