Botryoid nuclei resulting from cocaine abuse

Abstract

A blood count on a 32-year-old, seriously ill patient presenting to the emergency room, showed lymphocytosis (lymphocyte count 5.8 3 10 9 /L). A blood film was therefore examined. This showed numerous neutrophils with botryoid nuclei (top Image), lymphocytes with multilobated nuclei (top right Image), and monocytes with butterfly-and fanshaped nuclei (bottom left Image); basophils and eosinophils (bottom right Image, which also shows a lobulated large granular lymphocyte) also had botryoid nuclei. Two hours later a blood count from the patient, now in the intensive care unit, showed that the lymphocyte count had fallen to 0.50 3 10 9 /L and surprisingly the nuclear aberra-tions were no longer present. The history was then obtained that the patient had multiorgan failure and had presented with a temperature of 41.98C. Cocaine abuse was suspected and measures were taken to lower the body temperature. Subsequently, urinary breakdown products of drugs of abuse (opiates, cocaine, and cannabinoids) were detected.We were interested in the rapid disappearance of the abnormal leukocytes and sought to explain this by an in vitro experiment. A K 2 -EDTA-anticoagulated blood sample was incubated at 41.98C for 1 h. A blood count and films were then performed and these were repeated over the next 8 h with storage at ambient temperature (Table 1).