Leukemoid reaction in paraplegic male with pressure injuries: A case report

Leukemoid reaction is defined as leukocytosis of more than 50 × 10³ cells/µL of blood, which is a physiological response to stress or infections, as opposed to a primary blood malignancy (leukemia). It is seen in various conditions including sepsis, burns, and inflammatory states associated with systemic inflammatory response syndrome (SIRS). Here, we report a 40-year-old cachexic and paraplegic male who presented with a leukemoid reaction and pressure injuries at the gluteal region with a total leukocyte count (TLC) of 103 × 10³ cells/µL of blood and reactive thrombocytosis. A bone marrow (BM) examination revealed no malignancy. With the administration of broad-spectrum antibiotics, the TLC after two weeks at the time of discharge was reduced to 18.83 × 10³ cells/µL of blood and the patient was referred to surgical unit for further management of pressure injuries. BM examination is mandatory in patients with suspected malignancies; however, for bed-bound patients with longer durations, pressure injuries should be inspected and treated with broad spectrum antibiotics before performing invasive procedures such as a BM examination.