Blue-green cytoplasmic inclusions in neutrophils of a dog with fulminant liver disease

First case report

Abstract

Blue-green cytoplasmic inclusions in neutrophils have been referred in medical literature as “green crystals of death”, as a rare sign of poor prognosis, since death comes shortly particularly when associated with other laboratory findings of acute liver injury. There is no reports of these inclusions in veterinary literature up to date. The main goals of this case report are to describe, for the first time, neutrophilic inclusions in a dog who passed away two days after the detection and also to warn about the importance of these inclusions’ detection in veterinary haematology. A female stray dog of approximately 10 years old was admitted at UFPR Veterinary Hospital/Curitiba-PR after was rescued from the streets, victim of automobilistic trauma and remained hospitalized for eight days until its death. During this period, it was noted a progressive worsening of both clinical presentation and laboratory findings. At the morphological analysis of the blood smear, it was found blue-green inclusions within neutrophils cytoplasm. Liver enzymes released by hepatocytes damage (ALT and AST) and cholestasis (ALP and GGT) were significant increased, as well as serum lactate, contributing to the rapidly worsening of the clinical symptoms. This implies that the detection of these blue-green inclusions may serve as a marker of poor prognosis and may be associated with fulminant hepatic failure.