Klebsiella pneumoniae associated extreme plasmacytosis.
Infection-associated plasmacytosis is not uncommon; however, marked plasmacytosis in both peripheral blood and bone marrow that mimicks plasma cell leukemia is a very rare condition. We encountered a case of extreme plasmacytosis associated with Klebsiella pneumoniae sepsis in an aplastic anemia patient. A 42-year-old man presented with high fever of 5 days' duration. Hematological analysis revealed severe neutropenia and thrombocytopenia; his white blood cell count was 900/mm(3), with 26% of plasma and plasmacytoid cells in peripheral blood. Bone marrow biopsy and aspiration showed 25% cellularity with marked plasmacytosis (80%), highly suggestive of plasma cell leukemia. On the eighth hospital day, K. pneumoniae was identified in blood and sputum cultures. Fever improved after switching antibiotics, although his hematological condition worsened. His bone marrow cellularity (plasma cell proportion) progressively decreased: the values were 25% (80%), 10% (26%), 10% (11%), and < 10% (< 4%) on the 8th, 30th, 60th, and 90th hospital day, respectively. His plasmacytosis was extremely severe but was confirmed to be reactive with polyclonality. The present case represents the first report of strong suspicion of K. pneumoniae sepsis-associated marked plasmacytosis in an aplastic anemia patient.
Department of Laboratory Medicine, Inha University School of Medicine, Incheon, Korea.
Yeonsook
Y
Moon
Department of Laboratory Medicine, Inha University School of Medicine, Incheon, Korea.
Woo Ri
WR
Jang
Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
Hyeon Gyu
HG
Yi
Department of Pathology, Inha University School of Medicine, Incheon, Korea.
In Seo
IS
Park
Department of Laboratory Medicine, Inha University School of Medicine, Incheon, Korea.
Chung Hyun
CH
Nahm
Department of Laboratory Medicine, Inha University School of Medicine, Incheon, Korea.
Jong Weon
JW
Choi
Department of Laboratory Medicine, Inha University School of Medicine, Incheon, Korea.
Jin Ju
JJ
Kim
Department of Emergency Medicine, Inha University School of Medicine, Incheon, Korea.
Seung Baik
SB
Han
Aplastic anemia; Klebsiella pneumoniae; Plasma cell