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Blue-green neutrophilic inclusion bodies with concurrent liver failure as a predictor of imminent death
Antonio Sierra Rivera1, María García Valdelvira2, María A Elia Martínez1
1Servicio de Análisis Clínicos Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
Objectives:
Blue-green, birefractory, poorly-defined, cytoplasmic inclusions in some types of leukocytes are an underdiagnosed finding, which composition and clinical significance is not well understood. Inclusions are only found on peripheral blood smear (PBS).
Case Presentation:
We report the case of a male with a history of chronic disease (hypertension, obesity, dyslipidemia, and kidney failure) admitted to the emergency room (ER) with shortness of breath, who was later transferred to the intensive care unit (ICU). The patient had a torpid disease course and ultimately died of multiorgan failure, including severe liver failure. When his status exacerbated, these inclusions were observed on PBS in conjunction with liver enzyme abnormalities.
Conclusions:
This case confirms that blue-green inclusions on PBS in cases of acute severe liver failure with concurrent lactic acidosis should be immediately reported to the medical team, since it is suggestive of critical status and poor prognosis.
Insights
Blue-green cytoplasmic inclusions in leukocytes, observed on peripheral blood smears, may indicate critical illness and poor prognosis, particularly in patients with acute liver failure and lactic acidosis.
Area of Science:
- Hematology
- Clinical Pathology
- Cytology
Background:
- Blue-green cytoplasmic inclusions in leukocytes are an underdiagnosed finding.
- Their composition and clinical significance remain poorly understood.
- These inclusions are exclusively observed on peripheral blood smears (PBS).
Purpose of the Study:
- To report a case highlighting the potential significance of blue-green inclusions.
- To correlate the presence of these inclusions with critical illness and liver failure.
Main Methods:
- Peripheral blood smear (PBS) examination.
- Clinical case reporting and correlation with laboratory findings.
Main Results:
- A male patient with multiple chronic conditions presented with acute respiratory distress.
- The patient developed severe liver failure and lactic acidosis, with a fatal outcome.
- Blue-green cytoplasmic inclusions were observed on PBS during the patient's critical exacerbation, coinciding with liver enzyme abnormalities.
Conclusions:
- The presence of blue-green inclusions on PBS in acute severe liver failure with lactic acidosis is a critical finding.
- This finding suggests a critical status and poor prognosis.
- Immediate reporting to the medical team is crucial for patient management.
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