Infect Chemother.  2013 Dec;45(4):435-440. 10.3947/ic.2013.45.4.435.

Klebsiella Pneumoniae Associated Extreme Plasmacytosis

• Moon Y
• Jang WR
• Yi HG
• Park IS
• Nahm CH
• Choi JW
• Kim JJ
• Han SB

• KMID: 2170448
• DOI: http://doi.org/10.3947/ic.2013.45.4.435

Abstract

Infection-associated plasmacytosis is not uncommon; however, marked plasmacytosis in both peripheral blood and bone marrow that mimicks plasma cell leukemia is a very rare condition. We encountered a case of extreme plasmacytosis associated with 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% cellularity with marked plasmacytosis (80%), highly suggestive of plasma cell leukemia. On the eighth hospital day, K. pneumoniae was identified 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 extremely severe 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.

Keyword

Klebsiella pneumoniae; Plasma cell; Aplastic anemia

MeSH Terms

Adult
Anemia, Aplastic
Anti-Bacterial Agents
Biopsy
Bone Marrow
Fever
Humans
Klebsiella pneumoniae*
Klebsiella*
Leukemia, Plasma Cell
Leukocyte Count
Neutropenia
Plasma
Plasma Cells
Pneumonia
Sepsis
Sputum
Thrombocytopenia
Anti-Bacterial Agents

Figure

• 

  Figure 1 Schematic diagram of the patient's clinical course. The asterisk indicates the hospital day of bone marrow (BM) study; and inset, immunohistochemistry for kappa (left) and lambda (right). NG, no growth; PCs, plasma cells and plasmacytoid cells; CFPM, cefepime; CFX, ciprofloxacin; LFX, levofloxacin; VCM, vancomycin; MRPN, meropenem; AMK, amikacin; AMB, amphotericin B deoxycholate; H/E, hematoxylin and eosin.

• 

  Figure 2 (A) Chest radiograph on the fourth hospital day (HD) shows pneumonic consolidation. (B) Chest radiograph on the 15th HD shows clear lung fields. (C) Computed tomography on the 20th HD shows multiple necrotizing consolidations on both lungs, suggesting invasive fungal infection. (D) Lung biopsy shows septated fungal hyphae (Gomori-methenamine silver stain, original magnification × 400).

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