PMC5993353_01
(a) Peripheral blood smear showing eosinophilia with eosinophilic precursors, aberrant granulation, and vacuolisation (May-Grunwald-Giemsa staining, 500x). (b) Bone marrow aspirate showing hypercellular marrow with striking presence of eosinophils and eosinophil precursors with dysplastic features, abnormal nuclei and aberrant mixed granulation (May-Grunwald-Giemsa staining, 500x). (c and d) Bone marrow aspirate five months after the initial diagnosis of CEL showing increased number of myeloblasts with presence of Auer rods and mild dysplasia in the erythroid lineage (May-Grunwald-Giemsa staining, 500x).
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Complete blood count (CBC) showed leukocytosis (43.2 x 103/microL) consisting mainly of eosinophils (82%; 35424/microL) with aberrant granulation (Fig. 1a) and thrombocytopenia (34 x 103/microL). Bone marrow (BM) findings included a hypercellular marrow with striking presence of eosinophils and eosinophilic precursors with aberrant (mixed) granulation (Fig. 1b). BM aspirate confirmed eosinophilia and revealed mild dysplasia in the erythroid lineage together with an elevated number of myeloblasts (21%) with Auer rods, leading to a diagnosis of secondary AML (Fig. 1c-d).