case_images: PMC7750745_01
case_images: (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.
case_images: 10.1177_2050313X20957446-fig1.jpg
case_images: PMC7750745_01_10.1177_2050313X20957446-fig1.jpg
case_images: fig1-2050313X20957446
case_images: 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)).