Green neutrophilic inclusions in meningococcal sepsis

Shackleton, Louisa; Melotti, Dario; Leddy, Catherine; Glavey, Siobhán; Thornton, Patrick; Quinn, John F.

doi:10.1111/ijlh.13422

Cited by 3 publications

(4 citation statements)

References 6 publications

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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%

Section: Discussionmentioning

confidence: 99%

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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“…Our patient rapidly decompensated and expired within 36 hours of the inclusion bodies being identified, highlighting their prognostic value in critically ill patients and the high risk of mortality once identified. A review of the current literature suggests a strong temporal association between the identification of the inclusion bodies and the subsequent onset of multisystem organ failure, irrespective of the patient's specific underlying illness [ 8 - 10 ]. Thus, once these inclusion bodies have been identified, this critical result should lead physicians to consider implementing more invasive vital sign monitoring, more frequent lab draws, and additional imaging to evaluate for worsening organ injury or failure.…”

Section: Discussionmentioning

confidence: 99%

“…While acute liver injury and elevated lactic acid have been closely linked to the development of these inclusion bodies, it remains to be determined whether these inclusion bodies result from hepatic ischemia in the setting of septic shock or direct hepatotoxicity [1,3,7,[9][10][11]. The specific mechanism by which these inclusion bodies develop and what material constitutes these inclusion bodies are unknown.…”

Section: Discussionmentioning

confidence: 99%

Green Cytoplasmic Neutrophilic Inclusion Bodies in a Patient With Aspiration Pneumonia and Bowel Perforation

Wozniak¹,

Rampon²

2023

Cureus

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Blue-green cytoplasmic neutrophilic inclusion bodies, previously described as "green crystals of death," are a rare but likely underreported finding in critically ill patients. This finding is associated with high mortality, ranging from 31% to 100% in published case studies. These inclusion bodies have been most strongly associated with acute liver injury and lactic acidosis, but they have also been reported in critically ill patients secondary to other etiologies. Here, we report a case of blue-green neutrophilic inclusion bodies in a patient with aspiration pneumonia and severe pneumoperitoneum secondary to bowel perforation. These blue-green neutrophilic inclusion bodies offer high prognostic value for physicians, and their presence should be considered a "critical result," indicating the severity of the patient's illness.

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Acute myeloid leukemia with blue-green neutrophilic inclusions have different outcomes: two cases and review of the literature

Zhao,

Qiao,

Tong

et al. 2023

Clinical Chemistry and Laboratory Medicine (CCLM)

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Green neutrophilic inclusions in meningococcal sepsis

Cited by 3 publications

References 6 publications

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

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

Green Cytoplasmic Neutrophilic Inclusion Bodies in a Patient With Aspiration Pneumonia and Bowel Perforation

Acute myeloid leukemia with blue-green neutrophilic inclusions have different outcomes: two cases and review of the literature

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