Toxic Neutrophils inStreptococcus pneumoniaeSepsis

This is the authors' abstract. We don't add key points for this paper.

A previously healthy, 37-year-old woman presented to the emergency department obtunded and hypotensive. The previous night, a cough and sore throat had developed, and the patient had awoken with a purpuric rash and abdominal pain. Laboratory tests showed that the patient's white-cell count was 20,180 per cubic millimeter, with 5 percent metamyelocytes, 6 percent bands, 88 percent neutrophils, and 1 percent lymphocytes. Her platelet count was 41,000 per cubic millimeter. The tests also showed a depressed fibrinogen level and an elevated D-dimer level — findings consistent with the presence of disseminated intravascular coagulation. A peripheral-blood smear showed highly vacuolated neutrophils, . . .