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DOES LEUCOCYTOSIS ALWAYS MEAN A PYOGENIC INFECTION
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
Usually a report of leucocytosis calls for looking out for a pyogenic focus due to bacterial infection in a patient.
I would like to remind the family physicians that the following common conditions, which are not pyogenic, can cause leucocytosis:
1.AOSD (Adult Onset Still’s Disease). This is diagnosed when a young patient presents with acute rheumatoid arthritis syndrome and the blood test shows evidence of leucocytosis.
2.There are a number of liver conditions which can cause leucocytosis, without having pus in the liver e.g. amoebic necrosis and pus formation, alcoholic hepatitis and infarction of the liver due to acute vascular pathology.
3.Myocardial infarction or infarction in any other organ like spleen, pancreas, bowel etc can cause leucocytosis.
4.Finally, one of the best examples of a clinical condition where any clinician can be fooled is an ‘Acute attack of gout’. During this condition not only do the joint show all the signs of pyogenic inflammation like severe pain, severe tenderness, redness of the skin; even the blood count will show severe leucocytosis and the fluid aspirated from the joint will be yellow, like pyogenic pus. The diagnosis can be clinched only by looking for uric acid crystals in the fluid.
ACKNOWLEDGEMENTS
I am thankful to Dr. Sanjeev Amin for his suggestions.
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