case_images: PMC8426067_01
case_images: Bone marrow biopsy in a 17-year-old female with no significant past medical history. (a) H&E (400X magnification) section of the bone marrow biopsy, with trilineage hematopoiesis and a significant increase in eosinophils. (b) H&E (400X magnification) section of the bone marrow biopsy. (c), (d) Aspirate at high power (1000X magnification) showing an increase in mature eosinophils with occasional trilobed nuclei (arrow) and no increase in blasts.
case_images: CRIHEM2021-1142124.001.jpg
case_images: PMC8426067_01_CRIHEM2021-1142124.001.jpg
case_images: fig1
case_images: There was no increase in blasts, and some small hypolobated megakaryocytes were present (Figure 1).
case_images: PMC8426067_02
case_images: Bone marrow biopsy in a 33-year-old female with a past medical history of multiple sclerosis. (a) H&E (400X magnification) section of the bone marrow biopsy, with trilineage hematopoiesis and a significant interstitial increase in eosinophils. (b) Aspirate at high power (1000X magnification) showing mature eosinophils with rare trilobed nuclei (arrow) and no increase in blasts.
case_images: CRIHEM2021-1142124.002.jpg
case_images: PMC8426067_02_CRIHEM2021-1142124.002.jpg
case_images: fig2
case_images: A bone marrow biopsy revealed a relatively normocellular marrow (overall 60% cellularity) with trilineage hematopoiesis and marked increase in eosinophils (25% on aspirate); rare eosinophils showed abnormal lobation (trilobed forms) (Figure 2).
case_images: Trend of absolute eosinophil counts (k/ul) of both patients over time following treatment with steroid. Blue line: patient 1; orange line: patient 2. The arrows indicated steroid usage.
case_images: CRIHEM2021-1142124.003.jpg
case_images: PMC8426067_02_CRIHEM2021-1142124.003.jpg
case_images: fig3
case_images: Her eosinophil count decreased, from 7.4 k/ul to 0.1 k/ul, and she was discharged from the hospital 4 days later (Figure 3).