Acute Lymphoblastic Leukemia with Hypereosinophilia in a Child: Case Report and Literature Review

Abstract

Background: Hypereosinophilia in children can be primary or secondary. Numerous malignant diseases can cause hypereosinophilia, but it is seldom caused by acute lymphoblastic leukemia (ALL). In the event of protracted hypereosinophilia, it is extremely important to make a correct differential diagnosis. Case presentation: We present the case of an 11-year-old boy of Moroccan origin with ALL with hypereosinophilic onset (eosinophils in peripheral blood, 10,000/µL) in the absence of other signs of neoplastic disease, and compare this case with 61 similar cases in the literature. Following hospital admission, the patient initially presented with headache-caused nocturnal awakenings, evening fever, and cough, and he also lost approximately 7 kg in weight in a month not associated with sweating or itching. We first performed bone marrow aspiration, which showed an increase in eosinophils without cellular morphological abnormalities, and bone marrow immunophenotyping showed that 4.5% of cells had a phenotype compatible with lymphoid blasts. A lumbar puncture was negative. Given the poor marrow involvement, it was necessary to repeat a new bone marrow aspiration two days later, which showed an increase in blasts to 14%. A concomitant bone marrow biopsy showed an infiltration of blasts typical of B-cell ALL equal to 20–30% with associated hypereosinophilia. Cytogenetic analysis showed an hyperdiploid karyotype: 53–55, XY, +X, add(1)(q21q25), +4, +9, +10, +14, +2, +1, +21/46, XY. Conclusions: ALL is one of the possible causes of persistent hypereosinophilia. In patients with ALL and hypereosinophilia, peripheral hypereosinophilia can precede the appearance of blasts. Due to the negative prognosis and the increased risk of complications in these patients, bone marrow aspiration and biopsy are recommended if common causes of secondary hypereosinophilia are excluded.

Preventive Healthcare and Management for Acute Lymphoblastic Leukaemia in Adults: Case Report and Literature Review

“…Fever, joint pain, osteolytic bone lesions [ 33 , 34 , 35 , 36 , 37 , 38 ], bleeding manifestations, lymphadenopathy [ 39 ], frequent infection, coagulopathy, and hepatosplenomegaly are common [ 40 ]. Some individuals presented with abdominal pain, consciousness disturbance, nausea, weakness, constipation, numbness, hypereosinophilia [ 41 ], and atypical lymphoid cells in peripheral blood smears [ 42 ]. Hypercalcaemic crisis is a rare manifestation of ALL [ 43 ].…”

Pediatric Acute Lymphoblastic Leukemia With Hypereosinophilia and IDH2 Gene Mutation: A Case Report and Literature Review

“…It is also hypothesized that antigens expressed by tumor cells or other exogenous triggers such as viral infections stimulate the production of Th-2 cytokines and increase the production of eosinophilopoietic growth factors. 1,8 What makes this case unique is that this patient tested positive for an IDH2 gene mutation rather than the PDGFRA, PDGFRB or FGFR1 or PCM1-JAK2 genes that are known to be closely associated with eosinophilic myeloid/lymphoid neoplasms. In recent years, whole genome sequencing has revealed an increasing number of IDH mutations in a variety of hematologic malignancies including myeloproliferative and myelodysplastic diseases.…”

Cardiac Infiltration as the First Manifestation of Acute Lymphoblastic Leukemia: A Systematic Review

“…Notably, two B-ALL patients (17,18) presented cardiac mass as the first sign with remarkably elevated eosinophils in peripheral blood. In fact, in some cases, eosinophilia might be the initial presentation of B-ALL (38)(39)(40). As a large number of eosinophils might mask underlying or coexisting leukemia due to the absence of lymphoblasts in peripheral blood (37), the BMB is strongly recommended in patients presented cardiac mass with eosinophilia.…”