• Fatima Sharif Department of Hematology, Shifa International Hospital
  • Ayesha Junaid Department of Hematology, Shifa International Hospital
  • Khadija Ashraf




Acute Lymphoblastic Leukemia, eosinophilia, diagnosis


Peripheral blood eosinophilia is associated with a variety of benign and neoplastic conditions. Rarely, marked eosinophilia can mask an underlying Acute Leukaemia, delaying the correct diagnosis and treatment. Here, we report a case of 14-year-old boy, who presented with marked eosinophilia and space occupying lesion in the brain. Bone marrow biopsy and biopsy of brain lesion were performed to assess the underlying disorder, revealing the unexpected diagnosis of Precursor B- Acute Lymphoblastic Leukaemia in this patient. Cytogenetic studies revealed a normal male karyotype. This case highlights the significance of considering the rare possibility of Acute Lymphoblastic Leukaemia among the differential diagnosis of persistent eosinophilia in order to facilitate prompt and appropriate treatment.


Butt NM, Lambert J, Ali S, Beer PA, Cross NC, Duncombe A, et al. Guideline for the investigation and management of eosinophilia. Br J Haematol. 2017 Feb 10;176(4):553-72.

Larsen RL, Savage NM. How I investigate eosinophilia. Int J Lab Hematol. 2019 Apr;41(2):153-61.

Yu H, Wertheim G, Shankar S, Paessler M, Aplenc R, Pillai V. Marked eosinophilia masking B lymphoblastic leukemia. Am J Hematol. 2016:543-4.

Avramova B, Vlahova I, Banchev A, Bachvarov K, Stoyanova D, Konstantinov D. Hypereosinophilia as a Presenting Symptom of Acute Lymphoblastic Leukemia in a Child. Int J Clin Pediatr. 2020 Jun 18;9(2):59-63.

Spitzer G and OM Garson, Lymphoblastic leukemia with marked eosinophilia: a report of two cases. Blood, 1973. 42(3): p. 377-384.

Kaneko H, Shimura K, Yoshida M, Ohkawara Y, Ohshiro M, Tsutsumi Y, Iwai T, et al. Acute lymphoblastic leukemia with eosinophilia lacking peripheral blood leukemic cell: a rare entity. Indian J Hematol Blood Transfus. 2014 Sep;30(1):80-3.

Loghavi S, Kutok JL, Jorgensen JL. B-acute lymphoblastic leukemia/lymphoblastic lymphoma. Am J Clin Pathol. 2015 Sep 1;144(3):393-410.

Fournier B, Balducci E, Duployez N, Clappier E, Cuccuini W, Arfeuille C, et al. B-ALL with t (5; 14)(q31; q32); IGH-IL3 rearrangement and eosinophilia: a comprehensive analysis of a peculiar IGH-rearranged B-ALL. Front Oncol. 2019 Dec 10;9:1374.

Song G, Liu H, Sun F, Gu L, Wang S. Acute lymphocytic leukemia with eosinophilia: a case report and review of the literature. Aging Clin Exp Res. 2012 Oct;24(5):555-8.

Sahu KK, Malhotra P, Khadwal A, Sachdeva MS, Sharma P, Varma N, et al. Hypereosinophilia in acute lymphoblastic leukemia: two cases with review of literature. Indian J Hematol Blood Transfus. 2015 Dec;31(4):460-5.

Toboso DG, Campos CB. Peripheral eosinophilia as the first manifestation of B-cell acute lymphoblastic leukemia with t (5; 14)(q31; q32). Blood. 2017 Jul 20;130(3):380.

Matnani R, Weissmann D. Hyperdiploid B-lymphoblastic leukemia/lymphoma with hypereosinophilia and very few circulating lymphoblasts. Blood. 2020 Mar 19;135(12):974.

Ferruzzi V, Santi E, Gurdo G, Arcioni F, Caniglia M, Esposito S. Acute lymphoblastic leukemia with hypereosinophilia in a child: case report and literature review. Int J Environ Res Public health. 2018 Jun;15(6):1169.

Bhatti FA, Hussain I, Ali MZ. Adult B lymphoblastic leukaemia/lymphoma with hypodiploidy (-9) and a novel chromosomal translocation t (7; 12)(q22; p13) presenting with severe eosinophilia–case report and review of literature. J Hematol Oncol. 2009 Dec;2(1):1-6.

Lenk L, Alsadeq A, Schewe DM. Involvement of the central nervous system in acute lymphoblastic leukemia: opinions on molecular mechanisms and clinical implications based on recent data. Cancer Metastasis Rev. 2020 Jan 22:1-5.