Simultaneous appearance of leukemoid reaction and phlegmasia cerulea dolens

A leukemoid reaction is an extreme form of reactive leukocytosis defined as granulocyticleukocytosis above 50 × 109/L produced by normal bone marrow, mostly in response tosystemic infection or cancer. The mechanism as to how the haematopoetic system isaltered to elevate production of myeloid cells is not known.A 69-year-old man presented with phlegmasia cerulea dolens caused by massive iliofemoralthrombosis. His workout at admission revealed absolute white blood cell count of 73.4 × 109/L,with neutrophil granulocyte of 68.5 × 109/L. The new increase in white blood cell counthappened at day 5 after admission, when the haematoma of the anteromedial thigh wasevacuated in general anaesthesia. There was a gradual decrease in counts until they reachedthe normal range. Deteriorated general condition with signs of systemic inflammatoryresponse syndrome improved with supportive therapy, and the patient was discharged fromhospital after 30 days. During hospitalization we did not identify any infectious focus, or anymalignancy. We could not exclude other occult chronic conditions (malignancy) but thepatient did not develop any other condition during 4.5 years of follow-up.