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Alcoholic hepatitis with leukemoid reaction after surgery.

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.
AuthorsAngel M Morales, Luis A Hashimoto, David Mokhtee
JournalJournal 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
PMID16368495 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Glucocorticoids
  • Methylprednisolone
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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