Ma Fucun, Bai Mingjian, Liu Xuekai, Liang Guowei
Department of Clinical Laboratory, Aerospace Center Hospital, Beijing, China.
Am J Case Rep. 2024 Dec 20;25:e945185. doi: 10.12659/AJCR.945185.
BACKGROUND In several studies, the presence of Howell-Jolly body-like inclusions within neutrophils has been observed in cases of HIV infection, SARS-CoV-2 infection, post-transplant immunosuppression, and during chemotherapy or antiviral therapy. The phenomenon of neutrophils exhibiting Howell-Jolly body-like inclusions on peripheral blood smears can be attributable to viral infections or the pharmacological effects of medications. CASE REPORT A 14-year-old male patient who had received a diagnosis of lymphoblastic leukemia a year ago underwent hematopoietic stem cell transplantation and was readmitted due to a recurrence of gastrointestinal graft-versus-host disease (GVHD). During treatment, tacrolimus was administered in conjunction with steroids to treat GVHD, yet the patient's diarrhea worsened. Examination of a peripheral blood smear revealed neutrophils, with cytoplasmic inclusions resembling Howell-Jolly bodies. Despite an increased dosage of tacrolimus, control of GVHD was suboptimal, and there was a risk of gastrointestinal infection. During further treatment, the patient developed symptoms of gastrointestinal bleeding, which, upon gastroscopy and colonoscopy, led to the diagnosis of extensive gastrointestinal mucormycosis. The therapeutic regimen was escalated to include oral amphotericin B, while continuing tacrolimus and discontinuing all other immunosuppressants. CONCLUSIONS The present case highlights the presence of Howell-Jolly body-like inclusions within the cytoplasm of neutrophils observed in the peripheral blood smear of a patient after hematopoietic stem cell transplantation. Morphological analysis suggests that the emergence of these inclusions is highly likely to be induced by medications used in the treatment of GVHD.
背景 在多项研究中，已在人类免疫缺陷病毒（HIV）感染、严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染、移植后免疫抑制以及化疗或抗病毒治疗期间的病例中观察到中性粒细胞内出现豪-乔氏小体样包涵体。中性粒细胞在外周血涂片上呈现豪-乔氏小体样包涵体的现象可归因于病毒感染或药物的药理作用。病例报告 一名14岁男性患者，一年前被诊断为淋巴细胞白血病，接受了造血干细胞移植，因胃肠道移植物抗宿主病（GVHD）复发再次入院。治疗期间，给予他克莫司联合类固醇治疗GVHD，但患者腹泻加重。外周血涂片检查发现中性粒细胞，其胞质内包涵体类似豪-乔氏小体。尽管增加了他克莫司的剂量，但GVHD的控制效果欠佳，且存在胃肠道感染风险。在进一步治疗过程中，患者出现胃肠道出血症状，经胃镜和结肠镜检查后，诊断为广泛的胃肠道毛霉菌病。治疗方案升级为包括口服两性霉素B，同时继续使用他克莫司并停用所有其他免疫抑制剂。结论 本病例突出显示了在造血干细胞移植患者的外周血涂片中观察到中性粒细胞胞质内存在豪-乔氏小体样包涵体。形态学分析表明，这些包涵体的出现极有可能是由治疗GVHD所用药物诱导的。
