Welcome to the American Journal of Case Reports
Presently, only a fraction of case reports are useful for clinical decision-making and bedside-decision oriented research. Therefore, the aim of the Journal is to gather case reports across all medical disciplines, thereby integrating international medical knowledge.
A Case of Severe Sepsis Presenting Marked Decrease of Neutrophils and Interesting Findings on Dynamic CT
Isamu Makino, Hidehiro Tajima, Hirohisa Kitagawa, Hisatoshi Nakagawara, Tomoharu Miyashita, Shinichi Nakanuma, Hironori Hayashi, Hiroyuki Takamura, Sachio Fushida, Tetsuo Ohta
(Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan)
Am J Case Rep 2015; 16:322-327
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 pre... read more
Keywords: multidetector computed tomography, Neutrophils, Sepsis