Leukemoid Reaction in a Case of Chronic Cholecystitis With Focal Mild Acute Inflammation

Abstract

Leukemoid reaction is a rare condition of marked increase of the white blood cells (WBC) in the peripheral blood, mostly more than 50 × 10⁹/L. Although its most common cause is infection, acute or chronic cholecystitis has been hardly mentioned. This report aimed to present the leukemoid reaction found in a Thai who had chronic cholecystitis with focal acute inflammation. A 74-year-old woman had low-graded fever and generalized vague abdominal discomfort for 2 days. The physical examination showed the body temperature 37.7 °C and unremarkable abdominal signs. Her blood tests showed: hemoglobin 9.0 g/L, WBC 52.48 × 10⁹/L, neutrophil 91%, band form 1%, platelet 434 × 10⁹/L, and alkaline phosphatase (ALP) 290 U/L. The blood cultures yielded no growth. The computed tomography of the abdomen revealed 2 stones in the common bile duct (CBD) causing obstruction; the gall bladder (GB) showed mild dilatation with thin wall containing multiple small gall stones; no pericholecystic fluid and normal size of spleen. She promptly underwent operative cholecystectomy, CBD choledochoscopy, stones removal and T-tube choledochostomy. Along with the surgery, intravenous ertapenem was also administered. The pathology of the gall bladder was chronic cholecystitis with focal mild acute inflammation. With these therapies, fever daily decreased and finally disappeared within 5 days meanwhile the WBC count also gradually diminished every day till 8.04 × 10⁹/L within 7 days. The WBC count was still normal one month later. The diagnosis of leukemoid reaction was concluded and it was presumably be associated with chronic calculous cholecystitis with focal acute inflammation although the BCR-ABL translocation had never been explored.