PELGER-HUET ANOMALY MIMICKING SHIFT TO THE LEFT

A case report is presented of an 83-year-old male patient with respira tory distress, body temperature of 38.5-degrees-C, bilateral white inf iltrates on chest X-ray and ECG showing acute myocardial infarction. C linical evaluation led to the suspicion of severe infection accompanyi ng lung congestion due to the infarction, mostly because his white blo od cell differential count showed a persistent severe 'shift to the le ft'. Re-examination of his blood smear showed that the 'shift to the l eft' did not consist of band forms but of a 'Pelger-Huet' anomaly of t he granulocytes. Recognition of this anomaly in the light of rapid cli nical and radiological improvement precluded the administration of ant ibiotics for the diagnosis of severe infection with pulmonary involvem ent, which responded to diuretic therapy alone.