Clinical Images  |   April 2020
“Soccer-Ball” Lymphocytosis
Author Notes
  • From the University of Pittsburgh Medical Health System in Pennsylvania. 
  • Disclaimer: Dr Wright, a JAOA associate editor, was not involved in the editorial review or decision to publish this article. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to William F. Wright, DO, MPH, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205. Email:
Article Information
Imaging / Sports Medicine / Clinical Images
Clinical Images   |   April 2020
“Soccer-Ball” Lymphocytosis
The Journal of the American Osteopathic Association, April 2020, Vol. 120, 286. doi:
The Journal of the American Osteopathic Association, April 2020, Vol. 120, 286. doi:
An 87-year-old man with a history of paroxysmal atrial fibrillation, hypertension, and chronic kidney disease presented to the emergency department with confusion, weakness, and shortness of breath with nonproductive cough. Laboratory studies revealed a white blood cell count of 41,300 × 109/L, an absolute lymphocyte count of 23,500 × 109/L, a hemoglobin level of 9.8 g/dL, a platelet count of 280,000 × 109/L, and a creatinine level of 1.16 mg/dL. On physical examination, the patient had no hepatosplenomegaly, lymphadenopathy, bruising, or bleeding. An evaluation for infection or autoimmune conditions was unrevealing. A peripheral blood smear revealed smudge cells (image A) and small round lymphocytes with coarsely clumped chromatin (image B) characteristic of chronic lymphocytic leukemia (CLL; Wright-Giemsa stain). 

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