case_images: PMC9934935_01
case_images: Photomicrograph of peripheral blood smear, bone marrow aspirate smear, bone marrow biopsy, and immunohistochemistry (CD34). A: Peripheral blood smear displaying eosinophils* with dysplastic features such as sparse granulation, nuclear hypersegmentation/hyposegmentation, and cytoplasmic vacuolization along with the presence of occasional blast cells** (400X, Leishman stain). B: Bone marrow aspirate demonstrating cellular smear (100X, Leishman stain). C: Bone marrow aspirate smear showing myeloblasts* and eosinophils** having dysplastic eosinophilic precursors (400X). D: Trephine biopsy section displaying diffuse replacement of bone marrow by eosinophils and their precursors (100X, H&E stain). E: Increased eosinophils, their precursors**, and few blast cells* were also demonstrated in the trephine biopsy section (400X, H&E stain). F: Blast cells were highlighted by CD34 immunohistochemistry marker* in the bone marrow biopsy section.
case_images: cureus-0015-00000033858-i01.jpg
case_images: PMC9934935_01_cureus-0015-00000033858-i01.jpg
case_images: FIG1
case_images: A PBS study revealed an increased number of eosinophils and their precursors (74%), promyelocytes (03%), neutrophils (12%), lymphocytes (06%), and blasts (05%) (Figure 1A). Bone marrow aspirate smears were hypercellular and particulate, with 15% blasts, 60% eosinophils and their precursors, 7% myelocytes, 4% metamyelocytes, 3% neutrophils, and 11% erythroid cells (Figures 1B, 1C). Megakaryocytes were significantly diminished (Figures 1D, 1E). Immunohistochemistry for CD34 was performed on the bone marrow biopsy section which highlighted the occasional blast cells (Figure 1F).