"Green crystals of death”: a rare finding at the emergency room

Authors

DOI:

https://doi.org/10.32818/reccmi.a9n3a12

Keywords:

pneumococcal infection, acute liver failure, blue-green inclusions, clinical value

Abstract

The presence of blue-green inclusions in neutrophils, formerly known as “green crystals of death”, is a rare finding on
peripheral blood smear. The exact nature is unknown, associated with acute liver injury in critically ill patients and
high mortality rate, which varies from 30-100% within the next 24-72 hours. Their presence must be considered
as a critical value and the clinical laboratory specialist must report its finding to the physicians in order to prevent
multi-organ failure. We present a case of blue-green cytoplasmic neutrophilic inclusions in a patient with septic
shock and acute liver injury secondary to neumoccocal infection.

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References

Soos MP, Heideman C, Shumway C, Cho M, Woolf A, Kumar C. Blue-green neutrophilic

inclusion bodies in the critically ill patient. Clin Case Rep. 2019; 7(6):

-1252. doi: https://doi.org/10.1002/ccr3.2196 (último acceso nov. 2024). DOI: https://doi.org/10.1002/ccr3.2196

Rivera AS, Valdelvira MG, Elia Martínez MA, Martí ÁF, Benito GM. Inclusiones

azul-verdosas en los neutrófilos acompañadas de fallo hepático como señal

de muerte inminente. Adv Lab Med. 2022; 3(3): 299–302. doi: https:// DOI: https://doi.org/10.1515/almed-2022-0001

doi.org/10.1515/almed-2022-0001 (último acceso nov. 2024).

Huerto Aguilar JL, Martos Fustamante DL. Inclusiones azul-verdosas en

neutrófilos y monocitos: ¿resultados de riesgo crítico? Revista de salud

UDH; 5(3): 191-196. doi: https://doi.org/10.37711/rpcs.2023.5.3.424 (último DOI: https://doi.org/10.37711/rpcs.2023.5.3.424

acceso nov. 2024).

Haberichter KL, Crisan D. Green neutrophilic inclusions and acute hepatic

failure: clinical significance and brief review of the literature. Ann Clin Lab

Sci. 2017; 47(1): 58-61. Accesible en: http://www.annclinlabsci.org/content/

/1/58.long (último acceso nov. 2024).

Harris VN, Malysz J, Smith MD. Green neutrophilic inclusions in liver disease. J

Clin Pathol. 2009; 62(9): 853-4. doi: https://doi.org/10.1136/jcp.2009.064766 DOI: https://doi.org/10.1136/jcp.2009.064766

(último acceso nov. 2024).

Yang J, Gabali A. Green neutrophilic inclusions: current understanding and

review of literature. Curr Opin Hematol. 2018; 25(1): 3-6. doi: https://doi.

org/10.1097/MOH.0000000000000392 (último acceso nov. 2024).

Wozniak PS, Rampon GL. Green cytoplasmic neutrophilic inclusion bodies

in a patient with aspiration pneumonia and bowel perforation. Cureus.

; 15(7): e41318. doi: https://doi.org/10.7759/cureus.41318 (último acceso DOI: https://doi.org/10.7759/cureus.41318

nov. 2024).

Cantu MD, Towne WS, Emmons FN, Mostyka M, Borczuk A, Salvatore SP, et al.

Clinical significance of blue-green neutrophil and monocyte cytoplasmic inclusions

in SARS-CoV-2 positive critically ill patients. Br J Haematol. 2020; 190(2):

e89-e92. doi: https://doi.org/10.1111/bjh.16882 (último acceso nov. 2024). DOI: https://doi.org/10.1111/bjh.16882

Published

2024-12-31

How to Cite

1.
Fernández-Martín P, Torrado-Carrión RA, García-Corbalán M. "Green crystals of death”: a rare finding at the emergency room. Rev Esp Casos Clin Med Intern [Internet]. 2024 Dec. 31 [cited 2025 Feb. 5];9(3):143-6. Available from: https://www.reccmi.com/RECCMI/article/view/1070