Acute Eosinophilic Leukemia: The Challenges of Management in a Resource Poor Setting

Abstract

Introduction: The diagnosis of certain subtypes of leukaemia is rarely made and descriptions in the literature are scantily found. Aim: This report aimed to describe a case of acute eosinophilic leukaemia, highlighting the management challenges in Jos. Case Report: A 36-year-old female tailor presented in the emergency and accident unit of the hospital with fever, epistaxis and menorrhagia. She was transfusion for anaemia before presentation. She was bleeding from the nose, pale and febrile. Full blood count revealed severe anaemia, thrombocytopenia and eosinophilic leucocytosis. Bone marrow aspiration (BMA) cytology showed myeloid hyperplasia with eosinophilic myeloblasts. Supportive hydration, blood transfusion, ant-microbial agents and allopurinol were administered. The patient was counselled and Daunorubicin and Cytosine arabinoside (DA) regimen was commenced. Evaluation on days 14 and 28 revealed only improvement in clinical and laboratory features. Induction of remission was embarked upon again with DA regimen. On day 14 of re-induction, the haemogram remained essentially the same. She was maintained on the regiment for eight cycles when symptoms of fever and mucosal bleeding (gum) resumed, accompanied by raised WBC, severe thrombocytopenia, neutropenia and anaemia. She was on intravenous saline, fresh whole blood transfusion and antibiotic. Drugs regimen was changed to cyclophosphamide, vincristine, methotrexate and prednisolone. Conclusion: Rare forms of leukaemia when seen in the developing nations are faced with management limitations.