Chronic Neutrophilic Leukocytosis and Elevated Liver Enzymes with Persistent Body Ache: A Diagnostic Challenge

A 20-year-old nursing student reported experiencing intense body pains for the last two years, which worsened at night but showed some relief during the day. He also had elevated liver enzymes (SGPT: 216 U/L), and neutrophilic leukocytosis. Despite undergoing multiple tests, including bone marrow biopsy, genetic analysis (NGS panel of BCR-ABL, JAK2, and myeloid genes, and an autoimmune profile, a definitive diagnosis could not be reached. The patient developed body rashes, weight gain, high blood pressure, and mood swings, likely due to prolonged use of multiple antibiotics and, more recently corticosteroids. The patient’s body aches and rashes have persisted as chronic symptoms. The challenges highlight the challenges in the diagnosis of individuals with unexplained neutrophilic leukocytosis and underscore the need for further studies on the etiology, including lymph node involvement.