Hematology Case 39

Presented By Dr Mohammad Moharram

Released on 21/6/2020

Patient Data

49 year old male

Clinical Data

Patient has long history of DM and hypertension.

Patient had brain tumor 20 years ago. The tumor was removed surgically and ventriculoperitoneal (VP) shunt was inserted.

2 days ago patient was admitted in our hospital because of severe headache and dizziness.

C.T. brain showed pneumoceohalus involving upper lateral ventricles, no intracranial hemorrhage, and no brain oedema.

Related Laboratory Results

  • Fasting blood glucose: 8.6 mmol/L (R.R.: 3.9-5.6)
  • CBC:

WBC: 18.3 X 103 /uL (Neutrophils: 16.1 X 103 /uL - Lymphocytes: 1.6 X 103 /uL)

HGB: 15 g/dL

Platelets: 189 X 103 /uL

  • BUN: 9.8 mmol/L (R.R.: 2.5-6.4)
  • Creatinine: 162 umol/L (R.R.: 55-113)
  • AST: 44 u/L (R.R.: 15-40)
  • ALT: 90 u/L (R.R.: 17-63)
  • ALP: 186 u/L (R.R.: 32-91)
  • CSF sample was send to hematology lab (see below) and microbiology lab.

Case Picture(s) / Photo(s)

Giemsa Stain

Comment / Findings

  • CSF white cell count: 0.2 X 103 /uL
  • Giemsa Stained Film Show:

Neutrophils: 81%

Lymphocytes: 19%

Many Diplococci are seen in the Giemsa stained film for microbiological correlation.


Final Diagnosis

Secondary CNS bacterial infection (?? meningoencephalitis )

Additional Note

  • Gram stain reveled moderate number of gram negative diplococci.
  • CSF culture reveled acinetobacter baumani (MDR)