Howell-Jolly Body-Like Inclusions in a Case of Puerperal Sepsis: A Morphological Enigma

Howell-Jolly body-like inclusions (HJBLI) are cytoplasmic inclusions usually encountered in neutrophils or their precursors, and sometimes in monocytes. They are seen in immunosuppressed individuals, postantiviral or chemotherapy and Myelodysplastic syndrome patients and indicate dysgranulopoeisis. We report a case of HJBLI in a 19-year-old postpartum female who presented in labor and had anemia. She had a full-term normal vaginal delivery which was essentially without any complications. On day 3 postdelivery, she developed breathlessness. Peripheral smear examination revealed pancytopenia with a significant finding of a basophilic inclusion in the neutrophil. This inclusion was single, small, discrete, and basophilic, resembling a Howell-Jolly body but was found in a neutrophil. No other evidence of dygranulopoeisis in the neutrophil series was noted. HJBLI, if found, should be noted as well as need to be distinguished from other neutrophilic inclusions like Dohle bodies, Barr bodies or coarse granules seen in Chédiak-Higashi syndrome as they are separate entities.