Abstract |
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.
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Authors | Angel M Morales, Luis A Hashimoto, David Mokhtee |
Journal | Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
(J Gastrointest Surg)
Vol. 10
Issue 1
Pg. 83-5
(Jan 2006)
ISSN: 1091-255X [Print] United States |
PMID | 16368495
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Glucocorticoids
- Methylprednisolone
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Topics |
- Carcinoma
(surgery)
- Cecal Neoplasms
(surgery)
- Colectomy
- Fatal Outcome
- Fatty Liver
(complications)
- Glucocorticoids
(therapeutic use)
- Hepatitis, Alcoholic
(complications)
- Hepatocytes
(pathology)
- Humans
- Inclusion Bodies
(pathology)
- Leukemoid Reaction
(drug therapy, etiology)
- Leukocyte Count
- Liver Cirrhosis
(complications)
- Male
- Methylprednisolone
(therapeutic use)
- Middle Aged
- Postoperative Complications
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