Critical blue-green inclusions in neutrophil and monocyte cytoplasm in a healthy patient affected by COVID-19

Dienstmann, Guilherme; Comar, Samuel Ricardo; Souza, Matheus Leite Ramos de; Ruaro, Graziela; Leite, Luiz Arthur Calheiros

doi:10.1016/j.htct.2020.06.008

Cited by 2 publications

(2 citation statements)

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Section: Discussionmentioning

confidence: 99%

“…Notably, GI-positive cells have been identified in cases of acute liver failure caused by various pathogens, including Streptococcus pneumoniae, Clostridium perfringens, Escherichia coli, Enterococcus, Plasmodium falciparum, Aspergillus fumigatus, and even in the context of acute liver failure associated with SARS-CoV-2. [4][5][6][7] Patients with acute liver injury who present GI-positive cells typically experience a rapid escalation in transaminase levels, worsening clinical conditions within a short timeframe, and alarmingly high mortality rates. [8] However, there are exceptions to this dire prognosis, with reports suggesting that GI-positive cells can disappear, transaminase levels can decrease, and patients can recover, particularly when the underlying condition is effectively managed, as seen in middle-aged individuals with liver failure due to infections after antibiotic treatment.…”

Section: Discussionmentioning

confidence: 99%

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The green bad omen in blood smear and the potential of blood purification therapy: A case report

Chen,

Ni,

2024

Medicine

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Rationale: Green inclusions (GI) are distinct morphological features found in phagocytic cells like neutrophils and monocytes. These intracellular structures exhibit bright green color with unclear boundaries, and their origin and clinical significance are still not fully understood. GI carriers, often middle-aged to elderly with liver dysfunction, face higher mortality rates, earning them the nickname “inclusions of death.” This report presents a rare GI-related pediatric case, demonstrating a favorable response to blood purification therapy. Patient concerns: A 10-year-old girl was admitted with recurrent fever, abdominal pain, and neurological symptoms, culminating in a transient cardiac arrest. Blood tests revealed multi-organ injury and a high risk of disseminated intravascular coagulation, while peripheral blood smear detected GI within neutrophil cytoplasm. Diagnosis: The patient was diagnosed with acute necrotizing encephalopathy, severe sepsis, and multiple organ failure. Interventions and outcomes: After receiving multiple sessions of blood purification therapy, peripheral blood GI levels markedly decreased, accompanied by improvements in various laboratory parameters and signs of neurological recovery. Unfortunately, due to financial constraints, the family opted to transfer the patient back to their local hospital, where she succumbed shortly after discharge. Lessons: This case underscores the complexities in managing GI-related pediatric cases. Moreover, it emphasizes the potential benefits of blood purification therapy in such scenarios. Notably, this study highlights a potential correlation between the level of GI in peripheral blood and disease severity, particularly in pediatric cases. While these findings hold clinical significance for the treatment and management of GI-related patients, further research focusing on middle-aged and elderly individuals is imperative to elucidate the fundamental relationship between peripheral blood GI quantity and clinical presentation and to evaluate the efficacy of blood purification in GI-related cases.

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Section: Discussionmentioning

confidence: 99%