Thanks to Kendra Wulczyn for presenting an amazing case of a 68M w/ COPD who was found down, and found to have a leukocytosis and a cecal mass ultimately diagnosed with diffuse large B-cell lymphoma.
1. C.diff PCR cannot distinguish between colonization and infection. Approximately 10% of the population is estimated be colonized with C.diff
2. Neutrophilic leukocytosis usually represents infection. Other causes of polyclonal neutrophilia include drugs, autoimmune disease, and malignancy. Rarely, monoclonal neutrophilia occurs from myeloproliferative diseases.
3. The differential diagnosis of a cecal mass is extensive. Carefully consider structures adjacent to the cecum that may mimic a cecal mass (psoas abscess, tubo-ovarian abscess)
The vast majority of neutrophilic leukocytosis is infection. If an extensive search for infection is negative, consider the following list of non-infectious causes of neutrophilic leukocytosis.
*While you diligently rule out infection, the smear can provide clues to a non-infectious cause (e.g basophilia/eosinophilia may suggest myeloproliferative disease).
Rarely, the leukocytosis will be predominantly lymphocytic:
The differential diagnosis of cecal thickening is extensive, partly because of variety of structures adjacent to the cecum : ileum, lymph nodes, and appendix.
Before proceeding down the cecal thickening pathway, consider (and talk to your radiologist) processes adjacent to the cecum that can mimic a cecal mass (psoas abscess, tubo-ovarian abscess)