28 May 2015
: Case report
A Case of Severe Sepsis Presenting Marked Decrease of Neutrophils and Interesting Findings on Dynamic CT
Unusual clinical course
Isamu MakinoBCDEF, Hidehiro TajimaCD, Hirohisa KitagawaBCD, Hisatoshi NakagawaraCD, Tomoharu MiyashitaCD, Shinichi NakanumaCD, Hironori HayashiCD, Hiroyuki TakamuraCD, Sachio FushidaCD, Tetsuo OhtaCDEDOI: 10.12659/AJCR.893351
Am J Case Rep 2015; 16:322-327
Abstract
BACKGROUND: In a patient with severe sepsis, we sometimes observe immediate decrease of the counts of white blood cells (WBCs) and neutrophils, which is known as an indicator for poor prognosis. We observed marked decrease of white blood cells and neutrophils on blood examination and interesting findings on dynamic CT. Here, we present the case of a patient with severe postoperative sepsis occurring after major abdominal surgery and we discuss the mechanism of such clinical presentations.
CASE REPORT: A 60-year-old man received pancreatoduodenectomy with colectomy for pancreatic cancer. He developed a high fever on postoperative day 3. We observed marked decrease of WBCs and neutrophils on blood examination. We also observed slight swelling of the liver, inhomogeneous enhancement of liver parenchyma in arterial phase, and periportal low density in the Glisson capsule in portal phase, without any findings indicating infectious complications on dynamic CT. WBCs and neutrophils increased above normal range in just 6 hours. Blood culture examination performed while the patient had a high fever was positive for Aeromonas hydrophila. After receiving intensive care, he promptly recovered from severe sepsis. The CT findings disappeared on second dynamic CT examination performed 3 days after the first examination.
CONCLUSIONS: We treated a patient with severe sepsis after major abdominal surgery who presented very rapid change of the counts of WBCs and neutrophils and interesting CT findings in the liver. We rescued him from a critical situation by prompt and intensive treatment. Research is needed to accumulate and analyze data from more patients who present a similar clinical course to better understand their pathophysiological conditions.
Keywords: Leukocyte Count, Neutrophils - pathology, Pancreatectomy - adverse effects, Positron-Emission Tomography, Sepsis - diagnosis, Surgical Wound Infection - diagnosis, Tomography, X-Ray Computed
In Press
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.946956
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.946875
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.947289
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.946614
Most Viewed Current Articles
21 Jun 2024 : Case report
95,940
DOI :10.12659/AJCR.944371
Am J Case Rep 2024; 25:e944371
07 Mar 2024 : Case report
52,046
DOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
20 Nov 2023 : Case report
30,832
DOI :10.12659/AJCR.941424
Am J Case Rep 2023; 24:e941424
18 Feb 2024 : Case report
23,344
DOI :10.12659/AJCR.943030
Am J Case Rep 2024; 25:e943030