A case of myelodysplastic syndrome with marked eosinophilia showing favorable prognosis
A 67-year-old woman was admitted to our hospital in July 2007 with generalized weakness, dizziness, and dyspnea on exertion persisting for 5 years. Physical examination indicated a generally ill status. Abdominal examination revealed soft but distended abdomen, and no organomegaly was noted. Complete blood count (CBC) showed leukocyte count of 4.7×109/L, hemoglobin level of 6 g/dL, and platelet count of 140×109/L. Leukocyte differential count showed 39.3% segmented neutrophils, 22.1% eosinophils, 1% basophils, 29.3% lymphocytes, and 8.3% monocytes.\nBM examination showed normocellular marrow with an adequate number of megakaryocytes but dysplastic changes to the megakaryocytes and erythroid series. Increased promyelocytes with granules (14.6%), eosinophils (5.6%), and basophils (7%) were observed (). The patient's karyotype was normal (46 XX). Further molecular studies were recommended to the patient, but she refused, and therefore further evaluations were not carried out. The patient's initial diagnosis was MDS with eosinophilia and basophilia, which is subclassified as refractory cytopenia with multilineage dysplasia according to the 2008 WHO classification. After diagnosis, the patient was followed regularly. Her treatment did not include chemotherapies or BM transplantation; rather, she was conservatively managed by blood transfusion and medication to treat iron overload secondary to frequent transfusions. During the follow-up blood tests over 3 years, eosinophilia was continuously noted.\nIn August 2010, follow-up BM examination was performed. In the BM aspiration slide, hypercellular marrow with an adequate number of megakaryocytes and dysplastic changes in the erythroid series were noted. Promyelocytes with granules (11.9%) were still visible, and eosinophils (15.5%) with abnormal appearance were also detected (). These findings led to the diagnosis of MDS with chronic persistent eosinophilia. A recent CBC in January 2012 still showed a high proportion of eosinophils (20%) (). The patient visits our hospital for regular follow-ups; she is generally in good condition but requires occasional blood transfusion for her anemia.