Leukocytosis in Diabetic Ketoacidosis Without Infection: A Diagnostic Challenge.

Diabetic ketoacidosis (DKA) is a potentially life-threatening condition that requires prompt and precise management. While concurrent infection is a common precipitating factor, an elevated white blood cell (WBC) count does not necessarily indicate active infection. This case report illustrates a patient presenting with DKA and a high WBC count, but not showing any signs of infection. WBC level normalised after treatment of DKA, without the use of antibiotics. C-reactive protein and procalcitonin levels aided decision-making. Further studies are needed to validate the diagnostic value of these biomarkers and potentially establish a reliable tool to guide antibiotic stewardship. Reducing unnecessary antibiotic use in this context may significantly lower hospital costs and mitigate the growing threat of antimicrobial resistance. Optimising infection assessment in DKA patients remains an important clinical and research priority.