Shmuely H, Pitlik S D, Inbal A, Rosenfeld J B
Department of Internal Medicine, Beilinson Medical Center, Petah Tikva, Israel.
Neth J Med. 1993 Jun;42(5-6):168-70.
A case report is presented of an 83-year-old male patient with respiratory distress, body temperature of 38.5 degrees C, bilateral white infiltrates on chest X-ray and ECG showing acute myocardial infarction. Clinical evaluation led to the suspicion of severe infection accompanying lung congestion due to the infarction, mostly because his white blood cell differential count showed a persistent severe 'shift to the left'. Re-examination of his blood smear showed that the 'shift to the left' did not consist of band forms but of a 'Pelger-Huet' anomaly of the granulocytes. Recognition of this anomaly in the light of rapid clinical and radiological improvement precluded the administration of antibiotics for the diagnosis of severe infection with pulmonary involvement, which responded to diuretic therapy alone.
本文报告了一例83岁男性患者，该患者有呼吸窘迫症状，体温38.5摄氏度，胸部X光显示双侧白色浸润影，心电图显示急性心肌梗死。临床评估怀疑是梗死导致肺部充血并伴有严重感染，主要原因是他的白细胞分类计数显示持续严重的“核左移”。再次检查他的血涂片发现，“核左移”并非由杆状核细胞构成，而是粒细胞的“Pelger-Huet畸形”。鉴于临床和放射学迅速改善，识别出这种畸形后，未给予抗生素来诊断肺部受累的严重感染，仅通过利尿治疗该患者就有了反应。
