Alcoholic hepatitis with leukemoid reaction after surgery.
Alcoholic hepatitis (AH) is a clinicopathologic syndrome resulting from an excessive intake of alcohol. Leukemoid reactions (LRs) are characterized by a strikingly elevated granulocyte count over 40,000-50,000 cells/mm(3). Although a leukocytosis of 15,000-18,000 cells/mm(3) is frequently seen in AH, LRs are rare in this context. AH-associated LRs are a sign of poor prognosis and have a high mortality. A 64-year-old male with a history of heavy alcohol intake underwent a right hemicolectomy for cecal carcinoma. Preoperative laboratory data were normal with the exception of an albumin of 2.1 g/dL. Liver biopsies that were taken because of a nodular appearance revealed micronodular cirrhosis, steatohepatitis, and Mallory bodies. Postoperatively, the patient developed a leukocytosis that progressively increased to 72.6 cells/mm(3). He also developed signs of impaired hepatic and renal function. Extensive workup failed to reveal a source of infection. A trial of intravenous antibiotics had no impact on the leukocytosis. Methylprednisolone at a dose of 40 mg IV daily was started on postoperative day 9. The patient experienced a progressive decline in white blood count (WBC), which reached 25.2/mm(3) on postoperative day 14. However, he died on postoperative day 16. We conclude that the patient had AH-associated LR in the postoperative period, but died despite successful treatment of the LR with steroids.
Morales
Angel M
AM
Department of General Surgery, Texas Tech University Health Sciences Center at El Paso, 79905, USA. angel.morales@ttuhsc.edu
Hashimoto
Luis A
LA
Mokhtee
David
D
D002277:Carcinoma / Q000601:surgery; D002430:Cecal Neoplasms / Q000601:surgery; D003082:Colectomy; D017809:Fatal Outcome; D005234:Fatty Liver / Q000150:complications; D005938:Glucocorticoids / Q000627:therapeutic use; D006519:Hepatitis, Alcoholic / Q000150:complications*; D022781:Hepatocytes / Q000473:pathology; D006801:Humans; D002479:Inclusion Bodies / Q000473:pathology; D007955:Leukemoid Reaction / Q000188:drug therapy / Q000209:etiology*; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011183:Postoperative Complications
D005938:Glucocorticoids; D008775:Methylprednisolone