Green inclusions in neutrophils—a case report and review of literature

Green refractile inclusions in neutrophils are a very rare peripheral smear finding with few reported cases in literature. They were thought to be a marker of impending death with a very high mortality rate in the immediate hospitalization period. They were often seen in critically ill patients and often related to liver injury. Clinical and pathophysiologic characterizations of these inclusions are limited due to the rarity of this finding. We describe the case of a 42-year-old woman with tuberous sclerosis and recent renal transplantation who was critically ill due to pneumonia and had elevation of liver enzymes. She was found to have green refractile inclusions on peripheral blood smear on the third day of hospitalization. The patient improved rapidly with treatment and was discharged in 5 days. It appears that prognostic value of these inclusion bodies is doubtful. We also highlight the need to conduct further studies to clarify the link between hepatic injury and the presence of these inclusions.