Hyperleukocytosis, leukemoid reaction caused by malignant peritoneal mesothelioma: a case report and review of literature

Our plain-English summary of Hyperleukocytosis, leukemoid reaction caused by malignant peritoneal mesothelioma: a case report and review of literature, by K. Zhu, D. Zhou, K. Liu, et al (Frontiers in Oncology, 2025).

The study

• Authors: K. Zhu, D. Zhou, K. Liu, L. Wu, J. Jin, Z. Luo
• Journal: Frontiers in Oncology
• Published: 2025;15:1550868
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Paraneoplastic leukemoid reaction (PLR)-induced hyperleukocytosis remains a critical diagnostic challenge. Malignant peritoneal mesothelioma, known for its nonspecific clinical presentation, often evades early detection. We report a 75-year-old male with cirrhosis presenting with fever (38.2°C), progressive ascites, leukocytosis (109.9×109/L), and elevated CRP (247.41 mg/L). Initial diagnosis of spontaneous peritonitis failed to explain the leukocytosis, prompting bone marrow examination, including cytomorphology and genetic analysis, which turned out do not support a diagnosis of leukemia or myeloproliferative neoplasms. Subsequent peritoneal biopsy confirmed diffuse malignant peritoneal mesothelioma. Despite prompt diagnosis, the patient developed progressive multi-organ dysfunction and died on day 14. This case underscores the imperative to consider PLR as a potential cause of hyperleukocytosis in oncological contexts, rather than attributing it solely to hematological malignancies. Moreover, it highlights the importance of considering malignant peritoneal mesothelioma in the differential diagnosis of unexplained ascites and peritoneal thickening. Additionally, we propose the hypothesis that glucocorticoids may hold therapeutic potential in the management of PLR.

Copyright © 2025 Zhu, Zhou, Liu, Wu, Jin and Luo.

In plain English

This case report, with a brief literature review, described a 75-year-old Chinese man with chronic hepatitis B and liver cirrhosis. He had fever, abdominal pain, weight loss and fluid in the abdomen (ascites). His white blood cell count was 35.74 × 10^9 per liter on admission and rose to 109.9 × 10^9 per liter despite antibiotics. Blood and ascites cultures grew no bacteria. Bone marrow tests did not support leukemia or a myeloproliferative neoplasm. A peritoneal biopsy showed diffuse malignant mesothelioma, and the authors attributed the high white cell count to a paraneoplastic leukemoid reaction. Three days of methylprednisolone eased symptoms and lowered the counts, but only briefly. The patient chose palliative care and died of multiple organ failure on the 14th hospital day. The authors also tabulated 6 earlier published mesothelioma cases with this reaction. They concluded that very high white cell counts are not necessarily a sign of blood cancer and proposed that steroids may have a role. They noted that the report is retrospective and covers one patient. The article does not mention asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of a single patient with a brief review of previously published cases
• Who was studied: One 75-year-old Chinese man with chronic hepatitis B and liver cirrhosis, admitted to hospital (authors from Xiangtan Central Hospital, China); dates of admission not given
• Exposure: Not reported. The article gives no asbestos, fiber or occupational exposure history for the patient; it states only that he had never smoked or abused alcohol.
• Main results:
  • The patient's white blood cell count was 35.74 (×10^9/L) on admission, against a reference range of 3.9 to 9.1.
  • Despite broad-spectrum antibiotics, the patient's white blood cell count rose to 109.9 × 10^9/L and his C-reactive protein to 247.41 mg/L. Blood and ascites cultures were sterile.
  • Ultrasound-guided peritoneal biopsy showed diffuse malignant mesothelioma.
  • Bone marrow morphology, CSF3R mutation testing, BCR::ABL1 testing and karyotype did not support leukemia or myeloproliferative neoplasms in this patient.
  • The high white cell count was ultimately attributed to a paraneoplastic leukemoid reaction associated with diffuse malignant peritoneal mesothelioma.
  • The patient was given 40 mg of methylprednisolone daily for three days. His symptoms, white cell count and CRP improved, but the improvement was short-lived.
  • Serum interleukin-6 was raised in this patient. G-CSF was not tested.
  • The patient chose palliative care and died of multiple organ failure on the 14th day of hospitalization.
  • In the review part, the authors tabulated 6 previously reported cases of malignant mesothelioma with leukemoid reaction (pleura or peritoneum). The longest survival among those earlier cases was seven months.
• The authors' conclusion: The authors concluded that this case highlights rapid progression and early death with paraneoplastic leukemoid reaction secondary to malignant peritoneal mesothelioma. They said hyperleukocytosis is not necessarily a sign of a hematological malignancy and that histopathological examination is crucial in unexplained ascites and peritoneal thickening. They proposed, as a hypothesis, that glucocorticoids may have therapeutic potential.
• Limitations the authors state:
  • The report is retrospective and lacks a large patient cohort for analysis.
  • G-CSF was not measured because test reagents were lacking.

Topics

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Ascites, Neoplasm, Biopsy, Differential Diagnosis.

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