{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:03:01Z","timestamp":1756425781979,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,9,16]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>A leukemoid reaction is typically defined as white blood cell (WBC) count &gt;50\u00d710<jats:sup>9<\/jats:sup>\/L, predominantly neutrophil precursors, that are not due to tumour involvement in the bone marrow and not derived from clones. Leukemoid reactions associated with malignancy, known as paraneoplastic leukemoid reactions, are less common and are most notably seen with non-small cell lung cancer. A 64-year-old woman presented with right leg painful ulceration. On examination, she had multiple venous stasis ulcers more severe on the right, with no palpable pulses in her lower extremities. Her WBC count was 124\u00d710<jats:sup>9<\/jats:sup>\/L and platelets were 517\u00d710<jats:sup>9<\/jats:sup>\/L. Arterial dopplers showed limb-threatening arterial insufficiency which prompted right femoral endarterectomy. Few months earlier she was diagnosed with metastatic lung adenocarcinoma to the bone and she had leukemoid reaction with WBC 43.920\u00d7\u200910<jats:sup>9<\/jats:sup>\/L with 90% neutrophils. Repeat imaging showed progression of her malignancy and she passed shortly after. Inflammation is a key element of carcinogenesis and cancer progression. Among the different tumours, lung cancer is a non-haematologic malignancy that is most closely associated with leucocytosis. Some studies have found that leucocytosis was significantly associated with metastasis and shorter survival irrespective of other factors such as age or sex. The mechanism remains unclear however elevated levels of granulocyte colony-stimulating factor (CSF), granulocyte macrophage-CSF and interleukin 6 have been linked to this phenomena. The degree of leucocytosis seen in our patient is suggestive of CSF production leading to a paraneoplastic leukemoid reaction.<\/jats:p>","DOI":"10.1136\/bcr-2020-235389","type":"journal-article","created":{"date-parts":[[2020,10,13]],"date-time":"2020-10-13T17:00:18Z","timestamp":1602608418000},"page":"e235389","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Leukemoid reaction causing arterial thrombus in a patient with lung adenocarcinoma"],"prefix":"10.1136","volume":"13","author":[{"given":"Zena","family":"Chahine","sequence":"first","affiliation":[{"name":"Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yazan","family":"Samhouri","sequence":"additional","affiliation":[{"name":"Medical Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3636-0353","authenticated-orcid":false,"given":"Thejus","family":"Jayakrishnan","sequence":"additional","affiliation":[{"name":"Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dulabh","family":"Monga","sequence":"additional","affiliation":[{"name":"Medical Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,10,13]]},"reference":[{"key":"2025082801080193000_13.10.e235389.1","doi-asserted-by":"crossref","DOI":"10.1182\/blood-2018-99-115736","article-title":"Paraneoplastic leukemoid reaction associated with increased levels of and tumor overexpression of receptors for G-CSF, GM-CSF, and IL-6: a Clinico-Pathological-Molecular study","volume":"132","author":"Recio Boiles","year":"2018","journal-title":"Blood"},{"key":"2025082801080193000_13.10.e235389.2","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-10-0437"},{"key":"2025082801080193000_13.10.e235389.3","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.21100"},{"key":"2025082801080193000_13.10.e235389.4","doi-asserted-by":"crossref","first-page":"S4367","DOI":"10.21037\/jtd.2018.12.79","article-title":"Arterial events in cancer patients-the case of acute coronary thrombosis","volume":"10","author":"Oren","year":"2018","journal-title":"J Thorac Dis"},{"key":"2025082801080193000_13.10.e235389.5","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24480"},{"key":"2025082801080193000_13.10.e235389.6","first-page":"1405","article-title":"Hepatocyte growth factor production by neutrophils infiltrating bronchioloalveolar subtype pulmonary adenocarcinoma: role in tumor progression and death","volume":"63","author":"Wislez","year":"2003","journal-title":"Cancer Res"},{"key":"2025082801080193000_13.10.e235389.7","doi-asserted-by":"publisher","DOI":"10.1007\/BF00402777"},{"key":"2025082801080193000_13.10.e235389.8","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1182\/blood.V49.5.845.845","article-title":"Demonstration of granulopoietic factor(s) in the plasma of nude mice transplanted with a human lung cancer and in the tumor tissue","volume":"49","author":"Asano","year":"1977","journal-title":"Blood"},{"key":"2025082801080193000_13.10.e235389.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.semcancer.2013.02.005"},{"key":"2025082801080193000_13.10.e235389.10","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20011101)92:9<2399::AID-CNCR1588>3.0.CO;2-W"},{"key":"2025082801080193000_13.10.e235389.11","unstructured":"David Green MD . Leukocytosis associated with thrombosis. NEJM Journal Watch 2007."},{"key":"2025082801080193000_13.10.e235389.12","doi-asserted-by":"publisher","DOI":"10.1161\/01.ATV.0000156877.94472.a5"},{"key":"2025082801080193000_13.10.e235389.13","doi-asserted-by":"crossref","DOI":"10.1186\/1752-1947-6-211","article-title":"Leukemoid reaction in a patient with adenocarcinoma of the lung: a case report","volume":"6","author":"Riesenberg","year":"2012","journal-title":"J Med Case Rep"},{"key":"2025082801080193000_13.10.e235389.14","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19920315)69:6<1342::AID-CNCR2820690607>3.0.CO;2-U"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-235389","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:08:07Z","timestamp":1756368487000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-235389"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10]]},"references-count":14,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,10,13]]},"published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1136\/bcr-2020-235389"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-235389","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2020,10]]}}}