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Alcoholic hepatitis with leukemoid reaction after surgery
Angel M Morales1, Luis A Hashimoto, David Mokhtee
1Department of General Surgery, Texas Tech University Health Sciences Center at El Paso, 79905, USA. angel.morales@ttuhsc.edu
Summary
Leukemoid reactions (LRs) are rare in alcoholic hepatitis (AH) but indicate a poor prognosis. Steroids effectively treated the LR in this case, but the patient with AH still died post-surgery.
Area of Science:
- Hepatology
- Oncology
- Hematology
Background:
- Alcoholic hepatitis (AH) is a severe liver condition linked to excessive alcohol consumption.
- Leukemoid reactions (LRs), marked by extremely high white blood cell counts, are uncommon in AH.
- AH-associated LRs signify a grave prognosis and high mortality rates.
Observation:
- A 64-year-old male with a history of heavy alcohol use and cecal carcinoma developed severe leukocytosis post-hemicolectomy.
- Despite normal preoperative labs except for low albumin, liver biopsies revealed cirrhosis and steatohepatitis.
- The patient exhibited impaired hepatic and renal function, with no identifiable infection source.
Findings:
- The patient's white blood cell count escalated to 72.6 cells/mm(3), consistent with a leukemoid reaction.
- Intravenous antibiotics were ineffective, but methylprednisolone treatment led to a decrease in white blood cell count.
- Despite successful LR management with steroids, the patient succumbed to the illness.
Implications:
- This case highlights the rare occurrence of AH-associated LRs in the postoperative period.
- It underscores the poor prognosis associated with LRs in alcoholic hepatitis, even with treatment.
- The findings emphasize the need for careful management and monitoring of patients with AH and severe leukocytosis.
