Abstract
A 53-year-old female was admitted on June 11, 1984, because of general fatigue. Laboratory investigations disclosed thrombocytopenia and anemia. The leukocyte count was 4,000/μl including 29.5% immature eosinophils, and 2% blast cells. Dysplasia of granular distribution and nucleus were found in neutrophils and lymphocytes. The bone marrow biopsy showed a marked fibrosis. Surface marker analysis of the peripheral mononuclear cells showed an increase of CALLA+ cells. The chromosome abnormality (karyotype 45, XX, -4, -5, -13, -18, 19p+, +3mar) was found.
Two months after the admission, erythema exsudativum multiforme with high fever developed. The leukocyte count suddenly increased to 15,000/μl with 25% blast cells and 45% immature eosinophils. The patient died of sepsis and DIC. The autopsy showed a widespread infiltration of blast cells and immature eosinophils into the bone marrow, liver, spleen and other organs.
This case was considered to be an eosinophilic leukemia with myelofibrosis, myelodysplasia of hemopoietic cells of 4 series, and the terminal increase of the blast cells. It provides a clue to clarify the mechanism of proliferation and differentiation of stem cells in myelodysplastic syndrome and myeloproliferative disorders.
