Medicine · 2025
Neutrophil green inclusions combined with hemophagocytosis in peripheral blood after bee sting a case report and literature review.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
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Liang Ran, Li Jiaqi, Yan Xia, Cheng ZhengJiang, Fan Jiubo
Аннотация
RATIONALE: Neutrophils green inclusions serve as sensitive biomarkers for acute liver failure and lactic acidosis, demonstrating a strong correlation with short-term mortality, commonly referred to as "death inclusions." The combination of macrophage phagocytosis with neutrophil green inclusion is rarely reported, and this article discusses the clinical association and prognostic value of these 2 critical phenomena.
PATIENT CONCERNS: A 76-year-old female patient and an 82-year-old male patient both developed acute hepatic and renal failure, lactic acidosis, and multiple organ dysfunction syndrome following bee stings. Green inclusions in the cytoplasm of neutrophils and hemophagocytosis were detected in peripheral blood smears during hospitalization in both cases. Notably, both patients were elderly and had a poor prognosis.
DIAGNOSES: Multiple organ dysfunction syndrome due to bee sting.
INTERVENTIONS: Give endotracheal intubation ventilator-assisted respiration, perform plasma exchange to remove poison, perform continuous renal replacement therapy for blood purification to correct acidosis, use hormone anti-inflammation to stabilize cell membranes and the internal environment, implement fluid resuscitation and blood product transfusion, replenishment of albumin and parenteral nutritional support, and other therapies.
OUTCOMES: The conditions of both patients deteriorated rapidly following the discovery of neutrophils green inclusions, and resuscitation efforts were eventually abandoned by their families, leading to their discharge from the hospital.
LESSONS: The co-occurrence of neutrophils green inclusions and macrophage phagocytosis in peripheral blood smears indicates systemic cytokine storm and hepatic dysfunction, serving as an early prognostic marker for multiorgan dysfunction syndrome. Enhanced detection of these morphological abnormalities and their prompt clinical reporting are critical for assessing disease severity and outcomes. We propose integrating dynamic peripheral blood smear monitoring into the standard diagnostic protocol for critical cases of bee venom envenomation.
PATIENT CONCERNS: A 76-year-old female patient and an 82-year-old male patient both developed acute hepatic and renal failure, lactic acidosis, and multiple organ dysfunction syndrome following bee stings. Green inclusions in the cytoplasm of neutrophils and hemophagocytosis were detected in peripheral blood smears during hospitalization in both cases. Notably, both patients were elderly and had a poor prognosis.
DIAGNOSES: Multiple organ dysfunction syndrome due to bee sting.
INTERVENTIONS: Give endotracheal intubation ventilator-assisted respiration, perform plasma exchange to remove poison, perform continuous renal replacement therapy for blood purification to correct acidosis, use hormone anti-inflammation to stabilize cell membranes and the internal environment, implement fluid resuscitation and blood product transfusion, replenishment of albumin and parenteral nutritional support, and other therapies.
OUTCOMES: The conditions of both patients deteriorated rapidly following the discovery of neutrophils green inclusions, and resuscitation efforts were eventually abandoned by their families, leading to their discharge from the hospital.
LESSONS: The co-occurrence of neutrophils green inclusions and macrophage phagocytosis in peripheral blood smears indicates systemic cytokine storm and hepatic dysfunction, serving as an early prognostic marker for multiorgan dysfunction syndrome. Enhanced detection of these morphological abnormalities and their prompt clinical reporting are critical for assessing disease severity and outcomes. We propose integrating dynamic peripheral blood smear monitoring into the standard diagnostic protocol for critical cases of bee venom envenomation.