The existence of eosinophilic leukemia remains controversial since many authors challenge the existence of this entity. We present a patient with a hypereosinophilic syndrome whose findings were consistent with a leukemic process. The patient's course was marked by signs and symptoms of myeloblastoma formation and his illness terminated in an acute blastic crisis. Chromosome studies on peripheral blood leucocytes demonstrated aneuploidy and an abnormal number four chromosome with additional material on its long arm. This case appears to be an unusual example of a hypereosinophilic syndrome with both myeloblastoma formation and an abnormal leucocyte We wish to report a patient with a hypereosinophilic syndrome whose clinical picture was consistent with a myeloproliferative disorder. The patient had splenomegaly, myelofibrosis on bone marrow biopsy, a terminal blast crisis, and extensive myeloblastoma formation at autopsy. An abnormal karyotype of the peripheral blood leucocytes adds further support to the impression of a myeloproliferative process.
CASE REPORTA 44-year-old white male had enjoyed good health and taken no medication before developing myalgias, anorexia, and headache, followed in two months by the sudden onset of diplopia. He was admitted to a local hospital where physical examination was noteworthy for the presence of a right sixth nerve palsy. Laboratory studies included a hematocrit of 38%, white cell count of 9,900/mm3 with 47 polys, 12 bands, 31 lymphocytes, and 8 eosinophils. A chemistry profile, chest roentgenogram, brain scan, electroencephalogram, and lumbar puncture were all normal. Two months later, the patient developed right facial numbness and was admitted to the Massachusetts General Hospital. Pertinent physical findings included right periorbital edema without exopthalmos, a palpable spleen on deep inspiration, a right sixth nerve palsy and decreased right trigerninal nerve function. Laboratory data included a hematocrit of 38% and a white blood count of 17,600/mm3 with 28 polys, 4 bands, 2 metamyelocytes, 2 myelocytes, 42 eosinophils and 2 basophils. The peripheral smear was noteworthy for prominent teardrop erythrocytes. The platelet count was 162,000/mm3 and the sedimentation rate was 20 mm/hour. An electrocardiogram, chest roentgenogram, urinalysis and chemistry profile were normal. The Coombs test, LE prep, rheumatoid factor, total complement level and C3. and serum immunoelectrophoresis were either negative or within normal limits. An antinuclear antibody test was weakly positive at a titre of 1: 16 with a homogenous pattern. The leucocyte alkaline phosphatase and serum rnuramidase were both normal. Stool examination for ova and parasites was negative on several occasions. A bone marrow aspirate was a "dry tap." The marrow biopsy revealed myeloid h yperplasia with normal myeloid maturation and focal areas of eosinophilia and fibrosis. Reticulum was increased on the reticulum stain. A muscle biopsy was nondiagnostic. A lumbar puncture, including cytology, and a cranial CT scan w...
