NEUTROPHILIC HOWELL-JOLLY BODY-LIKE INCLUSIONS IN CONCURRENT HIV AND SARS COVID-19 VIRUS INFECTIONS

Abstract

Abstract Introduction/Objective Howell-Jolly bodies are nuclear remnants found in red blood cells in various conditions such as post-splenectomy, sepsis, sickle cell disease, alcoholism, autoimmune disorders (lupus), and post-bone marrow transplantation. Howell-jolly body-like inclusions have also been documented in neutrophils, rarely in monocytes, lymphocytes, and other myeloid cells. We report an interesting case of Howell-jolly body-like inclusions found in the neutrophils of a patient who is concurrently infected with HIV and the SARS-COVID-19 virus. Methods/Case Report A 59-year-old HIV-positive woman on darunavir, cobicistat, emtricitabine, and tenofovir alafenamide, is a current smoker and has a past medical history of COVID-19 pneumonia and persistent leukopenia. She presented with complaints of worsening cough, fever, and chills for 3 weeks. Her physical examination revealed diminished breath sounds at the bases of bilateral lungs. Her complete blood count (CBC) revealed white blood cells of 3.1 x 109/L, red blood cells of 2.55 x 1012/L, hemoglobin of 7.6 g/dL, and platelets of 164 x 109/L. Her last CD4 count was unknown and the current was 11. A SARS-CoV-2 PCR test was positive. Nucleic acid amplification tests for other respiratory viruses, Anaplasma and Babesia were negative. A computerized tomography scan of the chest showed multifocal pneumonia with a moderate pericardial effusion. Her beta-d-glucan level was within normal limits. The peripheral blood smear exhibited numerous neutrophils with basophilic, “Howell-Jolly body-like” inclusions within their cytoplasm. Dohle bodies were also present. Blood culture was positive for methicillin-sensitive Staphylococcus aureus. Her bone marrow biopsy showed normocellular marrow with maturing trilineage hematopoiesis and mild myeloid left shift. The patient was treated with vancomycin and piperacillin-tazobactam. Results (if a Case Study enter NA) NA Conclusion The presence of Howell-Jolly body-like inclusions in granulocytes is thought to be the result of stressed or dysplastic granulopoiesis secondary to immunosuppressive drugs, viral infections, chemotherapy, post- transplantation, or myelodysplastic syndrome. An association with HIV infection has been previously described. However, to the best of our knowledge, this is the first case of Howell-Jolly body-like inclusions in a patient with concurrent COVID-19 and HIV infections. These inclusions must be distinguished from other similar intracytoplasmic inclusions including Barr bodies, Anaplasma, and those seen in Chediak-Higashi syndrome.