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Pelger-Huët anomaly mimicking 'shift to the left'
H Shmuely1, S D Pitlik, A Inbal
1Department of Internal Medicine, Beilinson Medical Center, Petah Tikva, Israel.
The Netherlands Journal of Medicine
|June 1, 1993
Summary
A rare blood disorder, Pelger-Huet anomaly, mimicked infection in an elderly patient with heart attack. Prompt recognition prevented unnecessary antibiotics, highlighting the importance of careful blood smear examination.
Area of Science:
- Hematology
- Cardiology
- Pulmonology
Background:
- Elderly patients with acute myocardial infarction can present with complex symptoms.
- Respiratory distress and lung infiltrates in this population often raise suspicion for infection.
Observation:
- An 83-year-old male presented with respiratory distress, fever, and lung infiltrates post-myocardial infarction.
- Initial lab results showed a 'left shift' in white blood cell differential count, suggesting severe infection.
Findings:
- Re-examination of the blood smear revealed a Pelger-Huet anomaly, not a left shift, in granulocytes.
- Clinical and radiological improvement occurred rapidly without antibiotics, responding solely to diuretic therapy.
Implications:
- Pelger-Huet anomaly can be mistaken for infection, leading to inappropriate antibiotic use.
- Careful blood smear review is crucial for accurate diagnosis in patients with complex clinical presentations.
- This case underscores the importance of differentiating benign hematological conditions from infectious processes.