PMC7750745_01
(a) Peripheral blood smear at 50x magnification showing multiple peripheral
eosinophils showing relatively normal morphology. (b) Hypercellular bone
marrow core biopsy H&E at 20x magnification showing elevated eosinophil
count and slight dysmegakaryopoiesis seen. (c) Iron stain at 100x
magnification showing ringed sideroblasts present. (d) Colon biopsy H&E
at 20x magnification showing tissue infiltration of eosinophils and
eosinophilic cryptitis. (e) Giemsa stain of bone marrow aspirate 2 years
after initial bone marrow biopsy showing increased eosinophils. (f) Bone
marrow core needle biopsy H&E at 10x magnification showing increased
marrow cellularity from previous biopsy, with increased megakaryocytes and
eosinophils.
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PMC7750745_01_10.1177_2050313X20957446-fig1.jpg
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At the time of bone marrow biopsy, her blood cell counts showed a Hgb of 11.1 g/dL, 222k/microL, a WBC count of 13.6k/microL with a manual differential of 42% eosinophils (AEC of 6.3k/microL; image of peripheral blood eosinophils in Figure 1(a)). Bone marrow biopsy showed a hypercellular marrow for age (60% cellularity) with trilineage hematopoiesis and eosinophilia (19%) (Figure 1(b)). Iron stain on the aspirate smear showed increased ringed sideroblasts (Figure 1(c)). Colonoscopy with random site biopsy showed microscopic colitis with lymphocytic and eosinophilic infiltration and eosinophilic cryptitis (see Figure 1(d)). AEC. A second bone marrow biopsy was performed to rule out disease progression and showed markedly hypercellular marrow for age (95%) with marked eosinophilia (Figure 1(e) and (f)).