GREEN NEUTROPHILIC INCLUSIONS ASSOCIATED WITH ACUTE HEPATIC FAILURE SECONDARY TO SEPSIS

Case provided by: Sevetlana Kondratiev, MD

Case History

67 year old woman was admitted to the hospital with shortness of breath, abdominal pain and diarrhea. She was admitted with the clinical diagnosis of sepsis.She was found to have elevated WBCs count (12.6) with neutrophilic leukocytosis. On peripheral blood smear review bright green cytoplasmic inclusions of different shapes were noticed in neutrophils along with toxic granulation and cytoplasmic vacuoles (Images1-3, Wright stain, X100).

Diagnosis

GREEN NEUTROPHILIC INCLUSIONS ASSOCIATED WITH ACUTE HEPATIC FAILURE SECONDARY TO SEPSIS

Discussion
Green neutrophilic inclusions are unusual findings on peripheral blood smear and are previously described in patients with liver disease. It is suggested that these findings may be directly related to liver failure and may also serve as a poor prognostic indicator.

References
J Clin Pathol. 2009 Sep;62(9):853-4. doi: 10.1136/jcp.2009.064766.

Green neutrophilic inclusions in liver disease.
Harris VN, Malysz J, Smith MD.

Wright stain x100
Wright stain x100
Wright stain x100