Howell-jolly body-like inclusions in multiple leukocyte lineages: an underrecognized morphologic feature in a case of...

Howell-Jolly body-like inclusions (HJBLI) are most commonly observed in myelodysplastic syndromes, viral infections, or during immunosuppressive therapy. They predominantly appear in neutrophils, with occurrence across multiple leukocyte lineages being uncommon.

We report a rare case of multilineage HJBLI in a patient with severe sepsis, describe the associated morphological features, and discuss the clinical relevance to prevent misinterpretation in routine practice.

We present the case of a 23-year-old female patient with incomplete abortion complicated by severe Escherichia coli sepsis, corroborated by positive blood and vaginal cultures alongside markedly elevated procalcitonin and C-reactive protein levels. Peripheral blood smears (×1000 magnification) revealed round, densely basophilic inclusions morphologically consistent with HJBLI in neutrophils, eosinophils, and monocytes, with up to five inclusions per monocyte. Concomitant toxic changes, including prominent toxic granulation, Döhle bodies, and cytoplasmic vacuolization, were evident.

Multilineage HJBLI can be detected in the setting of severe sepsis, likely resulting from sepsis-induced nuclear fragmentation and dyspoiesis. This expands HJBLI's disease spectrum; familiarity with this morphology improves accurate recognition in routine hematological examinations.