Blue‐green neutrophilic inclusion bodies in the critically ill patient Michael P. Soos.pdf

该【Blue‐green neutrophilic inclusion bodies in the critically ill patient Michael P. Soos 】是由【周瑞】上传分享，文档一共【4】页，该文档可以免费在线阅读，需要了解更多关于【Blue‐green neutrophilic inclusion bodies in the critically ill patient Michael P. Soos 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。Received:26November2018?|?Revised:29March2019?|?Accepted:16April2019DOI:‐greenneutrophilicinclusionbodiesinthecriticallyillpatientMichaelP.?Soos1?|Caroline?Heideman1?|Cameron?Shumway1?|Min?Cho1?|Andrew?Woolf2?|Chintalapudi?Kumar31McLarenGreaterLansingInternalMedicine,Lansing,MichiganAbstract2McLarenGreaterLansingPreviouslytermed“GreenCrystalsofDeath,”brightblue‐greeninclusionbodiesGastroenterology,Lansing,,panyacuteliverfailure,lac-Lansing,Michigananfailure,,McLarenGreaterLansingKEYWORDSInternalMedicine,Lansing,‐greenneutrophils,cardiacarrest,criticallyill,greencrystals,shockliverEmail:Michael.******@med..edu1?|?INTRODUCTIONtransplantontacrolimusandmycophenolicacid,chronickidneydiseasestageIII,ar-Blue‐greenneutrophilicinclusionbodiesarearareclinicaldiomyopathy,hypertension,atrialfibrillation,,especiallyacutehepaticfailure,,ordingtodocumentationprovidedbyemergency61‐year‐oldmalepatientwhopresentedwithacutetoxicmeta-medicalservices,thepatienthadexperiencedmultipleepi---dynamicinstabilityandincreasingbloodureanitrogen(BUN),bloodandurinecultureswereandcreatinine,andindicatingsignsofrenalfailure,thepatientobtained,aperipheralbloodsmearorderedandthepatientwastransferredtotheintensivecareunit(ICU)ycinandpip-renalreplacementtherapy(CRRT)'seracillin/?‐ray(CXR)revealedbilateralpleuraleffusionscon-cardiaclifesupport(ACLS).(CT),‐greenneutrophilicinclu-atrophy,renalatrophy,(ECG)-sultedsecondarytoelevatedbloodureanitrogen(BUN)andmendedcontinuousrenalreplacement2?|?CASEREPORTtherapy(CRRT).ThepatientwasadmittedtotheIntensivecareunit(ICU)A61‐year‐,renalhypotensive(BP:91/41).PhysicalexamrevealedbibasilaressarticleunderthetermsoftheCreat?mo?nsAttri?butionLicense,whichpermitsuse,distributionandreproductioninanymedium,providedtheoriginalworkisproperlycited.?&SonsLtd./r3?|?1249?;7:1249–?|????,thein-107/65?mm?Hg164?,thefindingsoftheperipheralbloodsmearRespiratoryrateTemperaturewerefinalizedwhichrevealedpancytopeniawithmacrocytic40?°,tachycardiawithoutamurmur,,andthepatientre-?“greencrystalsofhematology.”Thepa-positiveairwaypressure(BiPAP)foradeterioratingrespi-tient',-Onthefourthday,thepatient'slacticacidosisandtrans-tion(ROSC).Thepatientrequiredthreeadditionalroundsaminasesimproved(Lacticacid:?mg/dL3,AST:144?U/L,ofACLSforatotalcumulativecodetimeofapproximatelyALT:1229?U/L);however,,thepatientwasintubatedwith--(EEG)revealingfindingsconsistentwithan-Laterthatmorning,',andthepatientwasPostarrestlaboratoryresults,fortcarewiththeagreementofthewardenandnext2,-?mg/(AST)>1600?U/Landalanineaminotransferase(ALT)of3?|?DISCUSSION3490?U/-Blue‐,,'--TABLE2?-Bilirubin(mg/dL),ursbetween48and72?hoursafterAST(unit/L)>(unit/L)>(unit/L)Thepathogenesisoftheblue‐(mg/dL)(mg/dL)‐prisedofWBC(K/μL)‐(g/dL)“wear‐and‐tear”pigmentfoundintheliver,Platelets(K/μL)96692818heart,kidney,retina,nervecells,(mmol/L),acutehepaticfailureeGFR(mL/min)26404749secondarytohypoxicinjuryresultsinthereleaseoflipofuscinLacticAcid(mg/dL3)(s):ALT,alanineaminotransferase;AST,aspartateaminotrans-2ferase;BUN,bloodureanitrogen;eGFR,estimatedglomerularfiltrationrate;intheformationofblue‐greeninclusionbodies.-WBC,,theseareseeninneutrophils,asionallybeSOOSetal.???|?1251FIGURE1?Photographstakenviadigitalmicroscopyshowingthepresenceofmultipleblue‐greeninclusionbodiesinvariousneutrophilsthroughoutthepatient'-perfusion,andrapidlossoflactatedehydrogenasesecond-sionsmaybesecondarytoblood‐,93%ofpatientsTheinclusionsaremostoftenassociatedwithacutelivershowedelevatedlactatelevelsonarterialbloodgases(ABG).failure,anfailuresecond-Inthiscase,thepatient'?mg/,andE?coli‐,whenlacticacidosiswaspresentwithre-alsuggestedthatcordedlactateof>5?mg/dL3,4,5themortalityratewas100%.theirpresenceisstronglyassociatedwithischemicliverin-Ourcasesupportsthecurrentliteraturepublishedandservesjury,urringinthecontextofshockorlivertrans-asaremindertocliniciansthatthepresenceofblue‐‐glutamylinclusionbodiesontheperipheralsmearinconjunctionwithtransferase(GGT)weredocumentedinamajorityofcases,lacticacidosiscanbeusedasapredictorofmortalityincrit-withameanpeakASTof2900?U/L,ALTof2024?U/L,?U/>1600and3490?U/L,,?hours,:servedastheprimaryauthors;CS:servedascorrelatedwiththepresenceoftheblue‐greeninclusions,thesecondaryauthor;MCandAW:servedasthesecond-whichwasalsoshowninourpatient';CK:characterizesamixtureofhigheroxygendemand,?|???,:clinicalsignificanceandbriefreviewofthelitera-?https:///0000-0002-4359-;47(1):58‐,!;123:,RuskovaA,ShuggCJ,McCallumVJ,,HeidemanC,Greenneutrophilandmonocyteinclusions–timetoacknowledgeandHowtocitethisarticle:;170(2):229‐,ChoM,WoolfA,‐,,,neutrophilicinclusionbodiesinthecriticallyillPA:Elsevier/Saunders;;7:1249–?://,MalyszJ,SmithMD./;62:853‐854.