SEVERE LEUKOMOID REACTION FOLLOWING NOREPINEPHRINE ADMINISTRATION IN A YOUNG ADULT WITH SEPTIC SHOCK: A CASE REPORT

Abstract

Background: Leukomoid reaction, defined as leukocytosis exceeding 50,000 cells/μL, is a rare hematological condition that can occur in various clinical settings. While commonly associated with severe infections and malignancies, its occurrence following vasopressor administration remains poorly documented in medical literature.

Case Presentation: A 23-year-old female presented with bacterial pneumonia that progressed to septic shock requiring vasopressor support. Following norepinephrine administration (0.1 mcg/kg/min), she developed severe leukomoid reaction with white blood cell count peaking at 61.99 x10³/μL. Serial complete blood counts demonstrated a clear temporal relationship between norepinephrine administration and extreme leukocytosis. The patient was managed with appropriate antibiotics and careful vasopressor weaning.

Results: Upon norepinephrine discontinuation, WBC counts decreased from 61.99 to 31.30x10³/μL within 24 hours and normalized to 15.63 x10³/μL over subsequent days. The patient maintained hemodynamic stability throughout the weaning process and achieved complete clinical recovery.

Conclusion: This case highlights a potentially underrecognized association between norepinephrine administration and leukomoid reaction, emphasizing the importance of hematological monitoring in patients receiving vasopressor therapy. Our findings suggest that medication-induced effects should be considered in the differential diagnosis of extreme leukocytosis in patients receiving vasopressor therapy.