Alcoholic leukopenic pneumococcal sepsis
Alcohol abuse and subsequent leukopenia led to a significant and devastating illness in a 55-year-old man. The patient presented with 2 day history of shortness of breath, cough, fever, chills, confusion, and altered mental status. The patient was found unconscious at the day of admission by a friend and there was no witnessed seizure or trauma. The patient was last seen conscious was 12 h before this presentation. The patient had a significant history of alcohol abuse with the multiple admissions to the hospital due to alcohol withdrawal.\nOn examination, he was unconscious. The patient was intubated on arrival and placed on assist- control mechanical ventilation. Vitals were significant for sinus tachycardia and hypotension that mandated the use of vasopressors. The chest shows right-sided decreased air entry with diffuse crackles. The rest of examination was unremarkable. Initial work-up revealed complete blood count shows white blood cells 0.8 × 109/L (reference range 4.5-11.0), absolute neutrophil count 360 mm3, hemoglobin 8.1 g/L (14.0-17.5), and platelets 109,000 and creatinine 3.5 mg/dl, potassium 4.5 meq/L. Chest X-ray showed right lower lobe consolidation with the right costophrenic angle obliteration suggestive of right pleural effusion []. Computed tomography - Angiography of the chest confirmed the findings of right lower lobe consolidation with no pleural effusion on both lung window [ transverse cut and b coronal cut] and mediastinal window [ transverse cut and b coronal cuts]. Bronchial secretions culture grows gram-positive diplococci (Streptococcus pneumoniae). Given the radiographic and microbacterial findings along the history of alcohol abuse and leukopenia, the diagnosis of “ALPS” syndrome was made. The patient initially was admitted to the intensive care unit and started on vancomycin and piperacellin/tazobactam antibiotics. Few days later, he made remarkable recovery and was discharged in stable condition.