Klebsiella Pneumoniae Associated Extreme Plasmacytosis
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Infection-associated plasmacytosis is not uncommon; however, marked plasmacytosis in both peripheral blood and bone marrowthat mimicks plasma cell leukemia is a very rare condition. We encountered a case of extreme plasmacytosis associatedwith Klebsiella pneumoniae sepsis in an aplastic anemia patient. A 42-year-old man presented with high fever of 5 days’ duration. Hematological analysis revealed severe neutropenia and thrombocytopenia; his white blood cell count was 900/mm3,with 26% of plasma and plasmacytoid cells in peripheral blood. Bone marrow biopsy and aspiration showed 25% cellularitywith marked plasmacytosis (80%), highly suggestive of plasma cell leukemia. On the eighth hospital day, K. pneumoniae wasidentified in blood and sputum cultures. Fever improved after switching antibiotics, although his hematological condition worsened. His bone marrow cellularity (plasma cell proportion) progressively decreased: the values were 25% (80%), 10% (26%),10% (11%), and < 10% (< 4%) on the 8th, 30th, 60th, and 90th hospital day, respectively. His plasmacytosis was extremelysevere but was confirmed to be reactive with polyclonality. The present case represents the first report of strong suspicion of K. pneumoniae sepsis-associated marked plasmacytosis in an aplastic anemia patient.
Abstract
Infection-associated plasmacytosis is not uncommon; however, marked plasmacytosis in both peripheral blood and bone marrowthat mimicks plasma cell leukemia is a very rare condition. We encountered a case of extreme plasmacytosis associatedwith Klebsiella pneumoniae sepsis in an aplastic anemia patient. A 42-year-old man presented with high fever of 5 days’ duration. Hematological analysis revealed severe neutropenia and thrombocytopenia; his white blood cell count was 900/mm3,with 26% of plasma and plasmacytoid cells in peripheral blood. Bone marrow biopsy and aspiration showed 25% cellularitywith marked plasmacytosis (80%), highly suggestive of plasma cell leukemia. On the eighth hospital day, K. pneumoniae wasidentified in blood and sputum cultures. Fever improved after switching antibiotics, although his hematological condition worsened. His bone marrow cellularity (plasma cell proportion) progressively decreased: the values were 25% (80%), 10% (26%),10% (11%), and < 10% (< 4%) on the 8th, 30th, 60th, and 90th hospital day, respectively. His plasmacytosis was extremelysevere but was confirmed to be reactive with polyclonality. The present case represents the first report of strong suspicion of K. pneumoniae sepsis-associated marked plasmacytosis in an aplastic anemia patient.
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