Botryoid neutrophils in sepsis caused by influenzae virus A

A 13-year-old patient was admitted to our hospital with severe respiratory distress, fever, and signs of meningeal infection. A positive result of swine flu was obtained by RT-PCR. All bacterial cultures were negative. Due to a worsening progression, the patient required mechanical ventilation. Leucocytosis with neutrophilia was observed with an absence of immature granulocytes and thrombocytopenia. A blood film was therefore examined, observing 85% of botryoid neutrophils, hypersegmented, and radially distributed nuclear lobs, and a large number of apoptotic cells. There was an elevated nucleus-cytoplasm ratio and neutrophils presented as slightly degranulated. The detection of botryoid nuclei in the neutrophils is a very infrequent finding and are usually found in cases of severe burns, hyperthermia, abuse of cocaine and methamphetamine, and encephalitis. Current studies also suggest that some morphometric measurements (cell population data [CPD]) can be altered in the case of sepsis and serious infection. In this particular case, [NE-SSC] = 159.9, [NE-FSC] = 94.6, and [NE-SFL] = 65.5, which correspond to measures of cellular complexity, size, and fluorescence and were above normal threshold values (performed by Sysmex XN20). Current studies directly relate the increase of NE-SSC > 149 in patients presenting with sepsis. The CPD and abnormal neutrophil morphology improved as the patient recovered. Results normalized by day 30 postdischarge.