case_images: PMC7787850_01
case_images: Bone marrow morphology: increased blasts, promonocytes, and atypical eosinophils with large basophilic granules.
case_images: CRIHEM2020-8822670.001.jpg
case_images: PMC7787850_01_CRIHEM2020-8822670.001.jpg
case_images: fig1
case_images: Importantly, there were increased eosinophils that had increased and coarse basophilic granules (Figure 1).
case_images: Representative G-banded karyogram showing (a) the inv(16)(p13.1q22) as a sole abnormality and (b) co-occurrence of inv(16)(p13.1q22) and t(9;22)(q34; q11.2). The arrows indicate the rearranged chromosomes.
case_images: CRIHEM2020-8822670.002.jpg
case_images: PMC7787850_01_CRIHEM2020-8822670.002.jpg
case_images: fig2
case_images: Two metaphases had pericentric inversions of chromosome 16 (Figure 2(a)). The second related clone was observed in majority of the metaphases, and each had a Philadelphia chromosome with the classic (9;22) translocation along with an inversion 16 abnormality (Figure 2(b)).
case_images: Fluorescence in situ hybridization (FISH) studies on interphase cells showing (a) CBFB and MYH11 rearrangement, dual fusion probe (Cytocell); (b) BCR/ABL1 translocation, dual fusion probe (Cytocell); and (c) normal FISH signal pattern for RUNX1T1/RUNX1 rearrangement, dual fusion probe (Abbott molecular).
case_images: CRIHEM2020-8822670.003.jpg
case_images: PMC7787850_01_CRIHEM2020-8822670.003.jpg
case_images: fig3
case_images: Fluorescence in situ hybridization (FISH) assays were positive for CBFB rearrangement and BCR/ABL1 translocation in 94.0~95.0% of the interphase nuclei (Figures 3(a) and 3(b)). A FISH assay for rearrangement of RUNX1T1/RUNX1 was normal (Figure 3(c)).
case_images: Fusarium infection presenting as a skin ulceration in his toes.
case_images: CRIHEM2020-8822670.004.jpg
case_images: PMC7787850_01_CRIHEM2020-8822670.004.jpg
case_images: fig4
case_images: Notably on day 20, the patient's clinical course was complicated by a skin ulceration in his toes that later resulted in disseminated Fusarium infection (Figure 4).
case_images: (a) Fluorescence in situ hybridization (FISH) studies on interphase cells showing BCR and ABL1 FISH probe signals, dual fusion probe (Cytocell) and (b) representative G-banded karyogram showing relapsed clone of the inv(16)(p13.1q22) primary clone.
case_images: CRIHEM2020-8822670.005.jpg
case_images: PMC7787850_01_CRIHEM2020-8822670.005.jpg
case_images: fig5
case_images: FISH and RT-PCR); however, the inv(16) clone resurfaced with other additional abnormalities significant for clonal evolution (Figure 5). Fungitell values were again high, and CT scan showed findings consistent with pneumonia and pansinusitis.