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The diversity of neutrophil inclusion bodies in fulminant sepsis
Author(s) -
Boyd Karen,
Tauro Sudhir
Publication year - 2018
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15218
Subject(s) - medicine , sepsis , procalcitonin , septic shock , inclusion bodies , gastroenterology , absolute neutrophil count , immunology , pathology , biology , escherichia coli , neutropenia , biochemistry , toxicity , gene
A 70-year-old man with a normal blood count underwent laparoscopic sigmoid colectomy for localised adenocarcinoma. He had no significant past medical history and was human immunodeficiency virus (HIV)-negative. Due to a post-operative anastomotic leak, emergency laparotomy and end-colostomy were performed, but he developed septic shock and required admission to the intensive care unit. Escherichia coli was subsequently identified in blood cultures. A full blood count showed: Hb 92 g/l, white cells 16.5 9 10/l, platelets 64 9 10/l and neutrophils 15.5 9 10/l. Levels of serum procalcitonin (2022 lg/l, antibiotic therapy strongly recommended at levels ≥1.0), C-reactive protein (580 mg/l, normal range (NR) 0-10) and lactate (6.8 mmol/l, NR 0.7–1.8) highlighted the severity of infection. Review of the blood film showed inclusions within neutrophils including D€ ohle Bodies (top left) and Howell–Jolly-like bodies (top middle and right). Other nuclear changes resembling Barr bodies (bottom left) and less dense fragments associating with, or following separation from, nuclear segments were also visible (bottom right). These features resolved as he improved. The presence of D€ ohle bodies (consisting of ribosomes and endoplasmic reticulum) within neutrophils during inflammation and infection is well recognised. In contrast, Howell–Jolly-like bodies, representing non-apoptotic nuclear fragments of neutrophils, have been described only in the occasional patient receiving immunosuppressive therapy or granulocyte colony-stimulating factor (G-CSF) or with HIV infection. These intracytoplasmic bodies can mimic infection-related inclusions due to anaplasmosis or ehrlichiosis, but our patient was not at risk of tick-borne diseases and improved despite no therapy for rickettsial disease. The concomitant presence of Howell–Jolly-like bodies and D€ ohle bodies (similar to that observed with therapeutic G-CSF) seen here may reflect developmental changes in neutrophils due to high levels of endogenous G-CSF in severe sepsis.