Leukemoid Reaction Research Articles

Unusual presentation of carcinoma gall bladder as paraneoplastic leukaemoid reaction and fever – A rare case report

Unusual presentation of carcinoma gall bladder as paraneoplastic leukaemoid reaction and fever – A rare case report

UNUSUAL LEUKEMOID REACTION IN A COVID-19 PATIENT: A CASE REPORT

A leukemoid reaction is a hematological disorder in which the White Blood Cells (WBCs) count may rise more than 50,000 per micro liter (μL) accompanied by an increase in Neutrophil precursors. The incidence of this reaction is uncertain. This looks like blood cancer but it is caused by reasons outside bone marrow like severe infections, drug reactions, intoxication, ischemia, inflammation and stress. The WBCs count falls back to normal once this cause is eradicated so we present an unusual case of leukemoid reaction with very high WBCs in a COVID19 patient to create awareness among physicians dealing with such cases.

Paraneoplastic leukemoid reaction: Case report and review of the literature

ObjectivesWe recently encountered a patient with unexplained hyperleukocytosis (105.4 K/μL at presentation), subsequently found to have colon cancer with a marked tumor-associated neutrophilic infiltrate; the leukocytosis abruptly improved after tumor removal. Paraneoplastic leukemoid reaction (PLR) is a rare entity, occurring due to tumor cytokine secretion (typically granulocyte-colony stimulating factor [G-CSF]). We describe a case and aggregate results of previously published cases. MethodsWe reviewed the English-language literature for all prior reports of PLR, recording age, gender, histologic diagnosis, WBC count, G-CSF level, and overall survival. We analyzed clinicopathologic variables’ impact on survival. ResultsWe identified 179 cases (mean age 64; 72 % M). Adeno-, squamous cell, sarcomatoid, and undifferentiated carcinomas accounted for >70 %. Esophagus, gallbladder, lung, liver, and pancreas were the most common primaries. At time of publication 81 % of patients had died, with mean overall survival of 4 months. There was no correlation between WBC count and G-CSF level. On univariate analysis, WBC count was the only variable associated with survival (P = 0.03). Patients with WBC counts >100 K/μL were twice as likely to die as those with counts from 11 K to 40 K/μL. ConclusionsPLR, typically carcinoma-associated, is characterized by dismal prognosis. The WBC count is inversely related to survival. Knowledge of this phenomenon militates against protracted, expensive work ups. In malignant neoplasms with prominent neutrophilic stroma, the pathologist should correlate with the WBC count and, if markedly elevated (>40 K/μL), raise consideration for PLR.

A case of alcoholic liver failure combined with leukemoid reaction

酒精性肝衰竭合并类白血病反应是较为罕见的疾病，临床诊断容易误诊或漏诊，主要依赖组织形态学及免疫组织化学确诊，目前以激素、保肝退黄、人工肝为主要治疗方法，治疗前后均需长期密切随访。.

Leukemoid Reaction in a Preterm Infant: Diagnostic Challenge in Resource Poor Setting: A Case Report

A preterm neonate delivered at 28 weeks gestation, mother had antenatal steroid. Blood counts showed leukemoid reaction, blood culture, procalcitonin and peripheral blood film was normal. Baby was stabilized in the NICU, recovered and the WBC count done serially showed a downward trend. The leukemoid reaction was presumed to come from antenatal steroid use. The diagnostic and management challenges encountered in managing the infant in resource constrained environment like ours is presented alongside.

Lurking Infantile Pertussis: Experience from a Tertiary Care Center in Northern India

Abstract Objectives The aim is to study the clinical laboratory profile and outcome of infants with laboratory confirmed pertussis. Methods In this retrospective study, records of 30 infants with laboratory confirmed pertussis, admitted to the pediatric department of a tertiary care hospital, were reviewed. Clinical features, laboratory parameters, and outcomes were noted. Results Median (interquartile range age was 10 (7–24.5) weeks, with a male preponderance. Large majority (60%) of enrolled infants were less than 16 weeks of age and nine (30%) developed pertussis even before 8 weeks of age. Cough was universal (100%), followed by rapid breathing (73%), fever (70%), and apnea (10%). Bubble continuous positive airway pressure (CPAP), nasal prongs oxygen, and invasive ventilation were required in 15 (54%), 11 (39%), and 2 (7%) infants, respectively; 12 (40%) needed to be admitted to the pediatric intensive care unit. Anemia was observed in 28 (93%) and leukemoid reaction in 15 (50%). All except one were discharged successfully. None of the mothers had received tetanus, diphtheria, and pertussis or Tdap vaccination during pregnancy. Conclusion Our study reports the continued occurrence of infantile pertussis in the community, suggesting reconsideration of our vaccination policy, including maternal immunization.

Rapid exacerbation featuring acute leukemoid reaction after retrolaparoscopic nephrectomy: a rare case report of renal cell carcinoma with postoperative comprehensive genomic profiling

BackgroundRapid lethal exacerbation and recurrence featuring acute leukemoid reaction (ALR) after retrolaparoscopic radical nephrectomy (RN) is a relatively rare clinical incident. Performing the reoperation for the patient and analyzing the tissue-based genetic mutation information postoperatively are a skill-demanding and meaningful task, which have been even more rarely reported.Case presentationWe present a case with a large right renal mass (13.0 × 10.0 × 8.0 cm). This 71-year-old male patient underwent the retrolaparoscopic RN in our department. The operation was technically precise and successful with final pathological diagnosis of hybrid (clear cell and papillary type) renal cell carcinoma (RCC). However, 10 days after the patient was discharged, he was readmitted with the chief complaint of high fever with severe right flank pain. CT scanning revealed that right retroperitoneal hematoma and the blood routine showed the dramatic elevation of white blood cell count (WBC). Even though the immediate broad-spectrum antibiotics were administered without delay and subsequent percutaneous puncturing and drainage was performed, the patient’s condition still exacerbated rapidly. In spite of the reoperation of hematoma evacuation, the patient died of multiple organ failure 10 days after the reoperation. The pathological result of reoperation showed the necrotic and hematoma tissue blended with RCC tumor cells (nuclear grading III), and both of the postoperative tissue-originated comprehensive genomic profiling by using the specimens from the RN and reoperation respectively indicated significant mutations of some oncogenes which might have potential relevance with ALR. Besides, both of the immunohistochemical (IHC) staining results from primary surgical renal mass and reoperative resected tissue revealed the positive expressions of granulocyte colony-stimulating factor (G-CSF).ConclusionsALR may be a predictor of poor prognosis in patients with RCC, and comprehensive genomic profiling as well as the alterative expression of G-CSF can help to provide potential valuable genetic etiological information and evidence for guiding the potential effective molecular-targeting therapy.

MORPHOLOGICAL CHARACTERISTICS OF PERIPHERAL BLOOD OF COWS INFECTED WITH BLV AND THE FREQUENCY OF REGISTRATION OF LEUKEMOID REACTIONS IN COWS WITH LEUKEMIA-AFFECTED HERDS

In controlled experiments during planned studies of cattle for leukemia, animals that showed leukemoid changes in blood – quantitative redistribution of granulocytes and agranulocytes-were identified. Individual analysis revealed that granulocytosis was detected in animals with inflammatory processes. In addition, the article presents comparative indicators of serum proteins in cows at the hematological stage of the leukemic process, with the manifestation of leukemoid reactions and in clinically healthy cows. Characteristic changes in the synthesis of immunoglobulins in cows with leukemia and leukemoid changes in the morphological composition of blood were established. With successful treatment of inflammatory processes, the hematological status of cows is restored to the initial indicators.

Paraneoplasic Leukemoid Reaction in Patient with Lung Carcinoma: Case Report and Literature Review

Paraneoplasic Leukemoid Reaction in Patient with Lung Carcinoma: Case Report and Literature Review

Excess leukocytosis (leukemoid reaction) associated with feline non-flea, non-food hypersensitivity dermatitis in a young cat

A one and a half-year-old, male, castrated, domestic short-haired cat was presented with a six‑month history of depression, anorexia, skin lesions, excessive itching and systemic lymphadenopathy. Complete blood count revealed severe leukocytosis (114,700 cells/μl), and peripheral blood films were characterized by marked lymphocytosis. Lymph nodes examinations and bone marrow aspirate were not suggestive of neoplastic changes. Histopathologic examination of skin lesions revealed allergic dermatitis. Based on the anamnesis and histopathologic features, non-flea, non-food hypersensitivity dermatitis (NFNFHD) was diagnosed. Treatment was initiated with prednisolone and cyclosporine. During the treatment, the cat fully recovered from the skin lesions. Leukocytosis was reduced to 18,940/μl six months after initiation of medication. To the authors’ knowledge, this is the first report describing a case of a leukemoid reaction secondary to feline NFNFHD.

Paraneoplastic syndrome in undifferentiated embryonic sarcoma of the liver

BackgroundThe undifferentiated embryonic sarcoma of the liver (UESL) is a rare, aggressive tumor mainly affecting children. Since UESL has no specific clinical symptoms or imaging characteristics, many cases of UESL are diagnosed late. The paraneoplastic leukemoid reaction (PLR) is a very rare concomitant of oncological patients associated with poor prognosis. This report describes the clinical course of a patient combining these two rare entities and describes the diagnostic challenges and dynamics of paraneoplastic syndrome.Case presentationWe report a case of UESL in a 46-year-old male who became clinically conspicuous due to pronounced B symptoms. CT and MRI showed a suspicious unifocal liver lesion. As the histological analysis of a tissue sample did not reveal a clear result, an 18F-FDG-PET-CT examination was performed. In addition to a high glucose metabolism of the liver lesion, an increased glucose metabolism in the entire bone marrow was observed. This finding was considered as pronounced paraneoplasia and laparotomy with liver segment resection followed. Immediately after resection of the tumor the paraneoplastic symptoms completely declined and the patient showed no signs of recurrence in the 1-year follow-up.ConclusionsAlthough UESL is rare and predominantly affects children, this diagnosis should always be considered for unclear unifocal cystic liver lesions, regardless of the patient’s age, as appropriate treatment has a good prognosis.

'Case Report: Leukemoid Reaction as an Incidental Finding in a Breast Cancer Patient'

'Case Report: Leukemoid Reaction as an Incidental Finding in a Breast Cancer Patient'

Disease in disguise – An unusual cause of leukocytosis in an infant – A case report and review of the literature

Leukocytosis with cytopenias of other cell lines and organomegaly in children pose a significant diagnostic challenge. Leukemoid reaction is exaggerated leukocytosis, whereas misinterpretation of nucleated red blood cells (nRBC) leads to spurious leukocytosis. These need to be considered in given clinical context to investigate further appropriately. We describe a report of 6 months infant who was referred with suspected acute leukemia based on initial evaluation when he presented with severe pallor and hepatosplenomegaly with white blood cell >50× ×109/L. He was later found to have spurious leukocytosis with an underlying hemolytic anemia. The strikingly normal platelet count, absence of blasts in smear and low mean corpuscular volume for age gave initial clues away from leukemia. This case emphasizes the need for systematic approach to clinical features followed by meticulous analysis of every parameter of hemogram and peripheral smear to arrive at appropriate diagnosis and to avoid unnecessary investigations.

Paraneoplastic leukemoid reaction associated with poor prognosis in oral squamous cell carcinoma: A case report and literature review

Paraneoplastic leukemoid reaction (PLR) is exceedingly uncommon syndrome in oral cancer and has implicated a worse outcome. This report describes a case of buccal mucosa cancer encountered PLR syndrome during the course of tumor progression. We conduct a literature review to highlight the relationship between PLR and the outcome in oral cancer. PLR is associated with rapid tumor growth and worse outcome in head-and-neck cancer.

Токсокароз у детей: эпидемиологические, клинические и лабораторные аспекты

Aim: to optimize the diagnosis of toxocariasis based on the analysis of epidemiological, clinical and laboratory data in children with the infestation. Patients and Methods: the analysis of official statistical data for the period of 2014–2018, literature sources, a retrospective analysis of 57 medical records of patients (40 children and 17 adults) who received treatment and diagnostic in the clinic of the Rostov Research Institute of Microbiology and Parasitology of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing in 2015–2018 was conducted. Results: a decrease in the incidence of newly diagnosed infestation cases was revealed (registered in the clinic of the Rostov Research Institute of Microbiology and Parasitology of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing). It correlated with official statistics (r=0.9, p=0.05). Based on clinical and laboratory examination, the diagnosis was established in 26 patients (45.6%). Among patients with a verified diagnosis of toxocariasis, the proportion of children aged 1 years and 1 months to 10 years old, was 96%. An analysis of epidemiological data showed that 76% of children had close contact with the soil. The infestation occurred in the form of latent toxocariasis in 36% of patients. In more than half of the cases, the disease was clinically manifested by geophagy (56.0%). A permanent laboratory parameter was the eosinophilic leukemoid reaction in patients with toxocariasis. Peripheral blood eosinophilia ranged from 15.66.2±9.31% in latent toxocariasis to 25.5±15.0 % in visceral toxocariasis. The positive rate in ELISA with Toxocara antigen was higher than that in the group of patients with visceral toxocariasis. However, there was no correlation between the eosinophilia level and positive rate (r=0.1, p=0.05). Conclusion: in areas where the incidence of toxocariasis and environmental contamination with invasive helminth eggs are high, it is advisable to perform tests of the peripheral blood in children at least one time per year in the autumn for timely diagnosis of infestation. The use of ELISA with Toxocara antigen is reasonable in the cases of peripheral blood eosinophilia. KEYWORDS: toxocariasis, statistics, incidence, eosinophilia, enzyme-linked immunosorbent assay, Toxocara antigen. FOR CITATION: Andreeva A.O., Golovchenko N.V., Zhuravlev A.S. Toxocariasis in children: epidemiological, clinical and laboratory aspects. Russian Medical Inquiry. 2020;4(11):670–675. DOI: 10.32364/2587-6821-2020-4-11-670-675.

Leukocytic Indices and Micronucleus in Erythrocytes as Population Markers of the Immune Status of Pelophylax ridibundus (Pallas, 1771) (Amphibia: Ranidae) Living in Various Biotopic Conditions

Abstract—A differentiated assessment of blood cells and types of micronuclei in the erythrocytes of marsh frogs (Pelophylax ridibundus) living in reservoirs of the Nizhny Novgorod region was performed. The water reservoirs differ by origin, morphology, and chemical composition. The specific abiotic conditions (a peat bog) and anthropogenic load resulted in the most pronounced change in the leukocyte differential count, corresponding to the neutrophilic type of leukemoid reaction, and in an increased micronucleus fraction in the erythrocytes. A moderate positive correlation between the increase in the number of disintegrated micronuclei and the content (mg/L) of nitrites in the reservoir was found (r = 0.72, p = 0.0179). The complex action of high concentrations of technogenic chemical pollutants (copper, chromium, and oil products) caused the activation of erythropoiesis and humoral immunity, which was confirmed by the nature of the leukemoid reaction of a lymphatic type. The cellular and humoral types of immune reaction aimed at self–foreign molecule differentiation provided stability of the frog ontogenesis under anthropogenic pressure. Integral leukocyte indexes, such as the blood cell indicator, the neutrophil–lymphocyte ratio, the lymphocyte–granulocyte index, and the index of leukocyte shift, which reflect the level of the body’s general reactivity, can be considered as population markers of the immune status of amphibians.

Paraneoplastic leukemoid reaction in a patient with metastatic adenocarcinoma of the lung

Paraneoplastic syndromes in lung malignancies can lead to leukemoid reaction with an elevation of eosinophils, neutrophils, and monocytes. The elevation of these three lineages together due to paraneoplastic syndromes has not been described in literature yet.

3184 A Case of Alcoholic Hepatitis With Unusual Leukamoid Reaction

INTRODUCTION: Leukemoid reaction is defined by predominantly neutrophilic leukocytosis with a total leukocyte count >50,000 cells/µl, after excluding leukemia. Leukemoid reaction is seen in various conditions. It is very rare in alcoholic hepatitis (AH). Herein, we present a case of a young alcoholic male who was admitted with alcoholic hepatitis and leukemoid reaction. He underwent extensive workup to rule out other etiologies and subsequently improved after glucocorticoid therapy. CASE DESCRIPTION/METHODS: 28-year-old male with history of alcohol abuse presented with a two-week history of abdominal pain, distention, jaundice and vomiting. On exam, the patient had a fever and tachycardia. He was also found to be icteric and had ascites. Investigations revealed a bilirubin of 9.4 mg/dl. WBC of 42,000 cells/µl with a left shift. Ultrasound showed enlarged fatty liver. MDF was 61 and MELD was 37. Septic workup was negative including ascitic fluid cell count and culture. He was started on prednisolone 40 mg. Hematologic workup including peripheral smear ruled out neoplasm. Leukocyte alkaline phosphatase was elevated at 249. The patient was discharged on prednisolone and was followed as an outpatient. He improved after four weeks and his WBC count normalized. DISCUSSION: Leukemoid reaction is a very rare event in AH and is a poor prognostic marker. The pathophysiology is likely due to the increased levels of granulocyte colony stimulating factor (G-CSF) released by the damaged hepatocytes. The release of excessive amounts of tumor necrosis factor-alpha has been postulated to be instrumental in the causation of leukemoid reaction in alcoholic patients as well. However, Arguelles-Grande et al. reported a patient in which the cytokine profile did not demonstrate increased amounts of TNF-a. In their patient, levels of IL-18 and IL-1b were increased. IL-1b stimulates the proliferation and maturation of neutrophils in the bone marrow both directly by the induction of granulocyte-macrophage colony-stimulating factor and G-CSF; thus the postulated pathogenic sequence for LR: increased IL-18 produces increased IL-1b, which along with increased IL-8 produces neutrophilia. In this setting, corticosteroids may play a role by their reported inhibition of IL-1b transcription. Hematologic evaluation in these cases is necessary to rule out underlying neoplasm. If patients with severe alcoholic hepatitis are found to have leukemoid reaction, treatment with steroids should be considered after excluding sepsis and neoplasm.

2274 Splenic Infarction in Alcoholic Hepatitis

INTRODUCTION: Case reports can be found in the literature describing elderly cirrhotic patients developing splenic infarctions (1,2). Herein, we describe a relatively young female who developed splenic infarction likely secondary to alcoholic hepatitis (AH). CASE DESCRIPTION/METHODS: A 40-year-old Caucasian female with past medical history of alcohol abuse and irritable bowel syndrome presented with jaundice, nausea, and vomiting. Laboratory showed ALT 54, AST 246, alkaline phosphatase 589, total bilirubin 14.0, INR 1.9, and ethanol level 240. WBC count was elevated to 20,900 with a 92% neutrophilic predominance. Leukocytosis was initially thought to be secondary to UTI as she also presented with urinary symptoms and urinalysis concerning for UTI. After a 5 day course of IV ceftriaxone, her WBC count decreased only to 18,400. Her abdominal exam began to worsen. RUQ ultrasound showed hepatic steatosis. CT scan with contrast showed moderate hepatomegaly and borderline splenomegaly with mild ascites. Abdominal pain, leukocytosis, and total bilirubin continued to worsen. Because of her severe abdominal pain and WBC count >50,000 despite a 7-day course of meropenem, contrast CT scan was repeated. At this time, lesions in the spleen concerning for infarction were seen. From here on, she was managed conservatively and her condition improved until discharge. DISCUSSION: Splenic function has been shown to decrease in patients with AH, but the exact pathophysiology is unclear (3). Splenic infarctions have been described in the literature in cirrhotic patients with co-morbidities (e.g. primary biliary cirrhosis), but to the authors’ knowledge there is not much mention in the literature of spontaneous splenic infarction in AH. In the right clinical context, physicians should consider splenic infarction in AH patients, especially in those with persistent leukocytosis which could be classified as a leukemoid reaction. Our report shows splenic vasculature infarction may be worth investigating in the future as an explanation for hyposplenia in AH.

Лейкемоїдні реакції та хронічні мієлопроліферативні захворювання у дітей: схожість і відмінності

Лейкемоїдні реакції та хронічні мієлопроліферативні захворювання у дітей: схожість і відмінності