Metastatic gallbladder carcinoma to the ovaries is occasional but a recognized entity. It can mimic, clinical and morphologically, a primary ovarian tumor, challenging the diagnosis. We present the case of a patient with a lump in the hypogastrium extending into the right iliac fossa and was found to have abdominopelvic cystic lesion with enhancing solid components and multiple sub-centimetric and ill-defined abdominal lymph nodes. Also, subpleural and parenchymal nodules in the lungs were present. She subsequently underwent a laparotomy. Cholecystectomy was also done due to pre-existing symptomatic biliary lithiasis. The histologic report described the ovarian involvement as metastases from a gallbladder carcinoma. The presentation of ovarian metastases can challenge the diagnosis. Hence, careful evaluation of the digestive tract and judicious use of immunohistochemistry should be considered in patients presenting with ovarian masses.

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Hemophagocytic lymphohistiocytosis (HLH) and erythema nodosum leprosum (ENL) result from a complex agent–host interaction and form a continuum of the same spectrum. A 30-year-old multi-gravida presented at 36 weeks gestation with fever and erythematous raised lesions over the face and upper and lower limbs after defaulting treatment for borderline lepromatous leprosy. Skin biopsy confirmed ENL, hence multi-drug therapy (MDT) and oral steroids were restarted. However, her condition worsened and she developed icterus, periorbital puffiness, pleural effusion, ascites and splenomegaly. Laboratory investigations showed pancytopenia, conjugated hyperbilirubinemia, transaminitis, elevated lactate dehydrogenase, hypertriglyceridemia, hyperferritinemia and hypofibrinogenemia. Dapsone was stopped on the suspicion of dapsone hypersensitivity but hyperbilirubinemia progressed. Diagnosis of HLH was clinched after bone marrow aspirate showed florid hemophagocytosis and subsequently, intravenous immunoglobulin (2 g/kg) over 5 days and dexamethasone were administered. The patient improved gradually with normalization of laboratory parameters and restarted MDT. This case depicts a rare and potentially catastrophic complication of ENL and emphasizes a vigil for HLH syndrome in such cases.

Context: Coronavirus Disease 2019 (COVID-19) has profound hematopoietic manifestations reflected in complete blood count (CBC) parameters and peripheral blood morphology. Aims: We aimed to evaluate CBC and peripheral blood morphology in COVID-19 patients and correlated them with severity, progression, and mortality. Settings and Design: Prospective observational study. Methods and Materials: Baseline and sequential blood samples were collected in 197 hospitalized COVID-19 patients, and CBC and morphology were assessed and compared with severity, progression, and survival. Statistical Analysis Used: Independent samples t-test for parametric continuous and Chi-Square and Fisher Exact for categorical variables. Results: Of the 197 patients, 84 (42.6%) were non-severe and 113 (57.4%) severe. The severe group displayed higher mean Total leukocyte count (TLC) (mean 11,772/μL SD 5445 vs. mean 7872/μL SD 3789, P < 0.0001), neutrophils (mean 81.2% SD 17.01 vs. mean 59.8% SD 14.55, P < 0.0001), and Red Cell Distribution Width-Standard Deviation (RDW-SD) (mean 30.04 SD 17.1 vs. mean 16.95 SD 6.63, P < 0.0001) with lymphopenia (mean 12.86% SD 15.41 vs. mean 30.64% SD 13.23, P < 0.0001) and monocytopenia (mean 4.62% SD 3.56 vs. mean 7.23% SD 3.06, P < 0.0001). The severe group had significantly more pseudo Pelger-Huet (62.8% (71/113) vs. 22.9% (14/61), P < 0.0001), abnormal nuclear projections (27.4% (31/113) vs. 3.3% (2/61), P < 0.0001), elongated nucleoplasm (17.7% (20/113) vs. 3.3% (2/61), P = 0.0073), shift to left (100% (113/113) vs. 21.3% (13/61), P < 0.0001), prominent granules (100% (113/113) vs. 85.2% (52/61), P < 0.0001), cytoplasmic vacuolations (100% (113/113) vs. 50.8% (31/61), P < 0.0001), ring (8.3% (3/113) vs. 4.9% (3/61), P = 0.0117), fetoid (15.04% (17/113) vs. 1.6% (1/61), P = 0.039), and nucleolated forms (53.9% (61/113) vs. 21.3% (13/61), P < 0.0001) with red cell agglutination (8.8% (10/113) vs. 0% (0/61), P = 0.0154) than non-severe patients. The non-severe group showed lympho-plasmacytoid (98.4% (60/61) vs. 37.2% (42/113), P < 0.0001), monocytoid (96.7% (59/61) vs. 25.7% (29/113), P < 0.0001), apoptotic (100% (61/61) vs. 17.6% (20/113), P < 0.0001), and nucleolated lymphocytes (78.7% (48/61) vs. 5.3% (6/113), P < 0.0001) with prominent granules (80.3% (49/61) vs. 12.4% (14/113), P < 0.0001), cytoplasmic vacuolations (83.6% (51/61) vs. 30.1% (34/113), P < 0.0001), and plasma cells (45.9% (28/61) vs. 19.5% (22/113), P = 0.0004). The progressors (9/84) had baseline leukocytosis (TLC mean 15,889/cu mm SD 4163.96 vs. mean 6940.27/cu mm SD 2381.59, P < 0.0001) and lymphopenia (lymphocyte% mean 18.11% SD 10.75 vs. mean 32.1% SD 12.75, P = 0.0022) with elevated RDW-SD (P = 0.032) at 7th to 10th day of illness. The 14 non-survivors had significant thrombocytopenia (mean 63.35 × 103/μL SD 30.72 vs. mean 230.77 × 103/μL SD 98.77, P < 0.0001) with lymphocytes nadir at day 9 without recovery versus day 7 to 8 nadir before recovery in survivors. Conclusions: The peripheral blood morphological features are distinct in severe and non-severe COVID-19 patients and baseline leukocytosis, lymphopenia, and elevated RDW-SD at day 7 of illness are useful indicators of disease progression.