Severe Lymphopenia as an Early Marker for Immunoparalysis in Massive Ischemic Stroke: A Case Report

Abstract

A 72-year-old female presented to the emergency room (ER) of Fatmawati Hospital with pneumonia and ketosis. After 12 h, her level of consciousness (LoC) decreased and she developed shortness of breath. In the ICU, antibiotics and supportive therapies were administered. After several hours, the need for vasopressors increased. Laboratory results showed severe lymphopenia, increased neutrophil to lymphocyte ratio (NLR) and D-Dimer levels. Septic shock and decreased LoC with severe immunoparalysis can be caused by intracranial process. A brain CT scan revealed massive ischemic stroke. Measures were taken to reduce intracranial pressure. Continuous Renal Replacement Therapy (CRRT) was performed for blood purification and immunomodulation. Vasopressor requirements decreased, her absolute lymphocyte increased and her NLR decreased. Diuresis and fluid balance were improved. She was subsequently discharged to the ICU. In this patient, massive ischemic stroke induced immunoparalysis, which manifested as lymphopenia and increased susceptibility to infection. Severe lymphopenia can be used as an early marker of ischemic stroke with signs of sepsis.

Abbreviations: CRRT - Continuous Renal Replacement Therapy; ER – Emergency Room; IFN-γ - Interferon-gamma; LoC - Level of consciousness; NLR - Neutrophil to lymphocyte ratio; SIIS - stroke-induced immunosuppression; TNF-α - Tumor Necrosis Factor-α

Key words: CRRT; Immunoparalysis; Immunomodulation; Lymphopenia; Massive Ischemic Stroke

Citation: Primayana B, Sugiarto A, Irawany V. Severe lymphopenia as an early marker for immunoparalysis in massive ischemic stroke: a case report. Anaesth. pain intensive care 2023;27(2):272−275; DOI: 10.35975/apic.v27i2.2139

Received: January 23, 2023; Reviewed: January 30, 2023; Accepted: March 10, 2023