The American journal of medicine
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Comparative Study
Marrow granulocyte reserves in black Americans. Hydrocortisone-induced granulocytosis in the "benign" neutropenia of the black.
The bone marrow granulocyte reserves of nine black patients with "benign" neutropenia were estimated by measuring the maximum neutrophil increment after the administration of hydrocortisone. Thirty control subjects, including 16 black and 14 white adults, were also studied. The mean neutrophil increment in the black patients with neutropenia was significantly less than that in the control subjects. ⋯ Four of the 16 black control subjects had neutrophil counts below 2,000/microliter; if these four are excluded from the analysis, the difference between the black and white control subjects is no longer significant. These data suggest that there is a subpopulation of healthy black adults with neutrophil counts below 2,000/microliter with reduced marrow granulocyte reserves as tested by corticosteroids. Bone marrow aspirates in four of the neutropenic patients showed normal cellularity and myeloid maturation suggesting that the lower increments are due to a difference in granulocyte release rather than to a difference in granulocyte production.
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Fever patterns associated with pulmonary thromboembolism have not been well characterized. Upon review of 35 consecutive patients with angiographically documented pulmonary emboli, fever was present in 24 patients; and in 20, it was attributed solely to pulmonary thromboembolism. ⋯ Fever persisting beyond six days, however, especially with temperatures over 38.5 degrees C, should not be ascribed to pulmonary thromboembolism unless other causes have been carefully excluded. If the clinical setting and patient's findings are consistent with pulmonary thromboembolism, one should not be deterred from presumptively making this diagnosis and initiating therapy because of the presence of high fever.
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Case Reports
Corynebacterium pseudotuberculosis. A new cause of infectious and eosinophilic pneumonia.
A 28 year old veterinary medical student experienced spiking fever, cough, peripheral blood eosinophilia and an eosinophilic pulmonary infiltrate. Corynebacterium pseudotuberculosis was isolated from a transtracheal aspirate and bronchoscopy washings. ⋯ In our patient specific antibodies against the isolated C. pseudotuberculosis developed but not against the other corynebacteria. With erythromycin therapy, the peripheral blood eosinophilia and IgE anti-C. pseudotuberculosis titer decreased whereas the IgG titer continued to increase.