#00065851

A 50-year-old female who presented with fatigue, mucosal bleeding, and unusual peripheral blood findings. Complete blood count revealed a leukocytosis (WBC 73,260 K/cmm) with absolute monocytosis (37,360 K/cmm) and 9% circulating blasts. Peripheral blood examination demonstrated bright blue-green inclusions within the cytoplasm of mature neutrophils and monocytes. Bone marrow examination and flow cytometry showed 60% involvement by monocytic blasts/promonocytes, confirming AML. Concurrently, additional labs revealed transaminitis (ALT 152 U/L; AST 103 U/L) compatible with acute liver injury. In this case, the presence of blue-green inclusions was correlated with acute liver injury, which is reported as a clinical phenomenon likely due to leukemic infiltration of the liver. Blue-green inclusions may indeed represent a harbinger of poor morbidity for a patient with myeloid neoplasm.