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. 2022 Jul 7;3(3):295-302.
doi: 10.1515/almed-2022-0060. eCollection 2022 Oct.

Blue-green neutrophilic inclusion bodies with concurrent liver failure as a predictor of imminent death

[Article in English, Spanish]
Antonio Sierra Rivera  1 , María García Valdelvira  2 , María A Elia Martínez  1 , Ángeles Férez Martí  1 , Goitzane Marcaida Benito  1
Affiliations

Blue-green neutrophilic inclusion bodies with concurrent liver failure as a predictor of imminent death

[Article in English, Spanish]
Antonio Sierra Rivera et al. Adv Lab Med. .

Abstract

Objectives: Blue-green, birefractory, poorly-defined, cytoplasmic inclusions in some types of leukocytes are an underdiagnosed finding, which composition and clinical significance is not well understood. Inclusions are only found on peripheral blood smear (PBS).

Case presentation: We report the case of a male with a history of chronic disease (hypertension, obesity, dyslipidemia, and kidney failure) admitted to the emergency room (ER) with shortness of breath, who was later transferred to the intensive care unit (ICU). The patient had a torpid disease course and ultimately died of multiorgan failure, including severe liver failure. When his status exacerbated, these inclusions were observed on PBS in conjunction with liver enzyme abnormalities.

Conclusions: This case confirms that blue-green inclusions on PBS in cases of acute severe liver failure with concurrent lactic acidosis should be immediately reported to the medical team, since it is suggestive of critical status and poor prognosis.

Keywords: green crystals of death; lactic acidosis; severe liver disease.

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Conflict of interest statement

Competing interests: Authors state no conflict of interest.

Figures

Figure 1:
Figure 1:
Blue-green cytoplasmic inclusions in peripheral blood smear (May-Gründwald Giemsa).
See this image and copyright information in PMC

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