The article entitled “Auer Rod in a Neutrophil in a Nonmalignant Condition”, written by Chandra et al. [1] and published in a recent issue of your journal, was quite interesting. Here we would like to emphasize some relevant points.This article demonstrates why peripheral smears, bone marrow examination, and genetic tests are mandatory. Acute myeloid leukemia must be excluded. Electron microscopic analyses would be helpful. The title is overly assertive. It may be called an Auer rod-like image.It is not known why Auer rods are not seen in non-neoplastic cells. However, there have been some hypotheses on the genesis of Auer rods, including infectious microorganisms, abnormal nucleoplasm segregation, pathologic forms of azurophilic granules, and cytoplasmic pH alteration. Unsuccessful results in Auer body inoculation experiments led to the elimination of the infectious microorganism theory. Although the conditions for pH alteration are not known, Ackerman [2] suggested that cytoplasmic pH alteration occurred in specific leukemia cells, which allowed the granules to unite into crystal-like rods [3].Additionally, a titration rate of 1/200 or higher in O antigen should be considered positive for acute infection diagnosis. Salmonella Typhi isolation in culture is the gold standard for diagnosis [4].Conflict of Interest: The authors of this paper have no conflicts of interest, including specific financial interests, relationships, and/or affiliations relevant to the subject matter or materials included.
Dear Sir,
The authors are thankful for considering their manuscript entitled “Auer Rod in a Neutrophil in a Nonmalignant Condition” interesting enough for critical analysis. However, the authors would like to clarify few points:1. The authors have clearly stated in the manuscript the presence of Auer rod-like inclusions on peripheral examination.2. In view of the presence of Auer rods bone marrow examination was done and which showed only unremarkable features of normoblastic maturation. There was presence of no leukemia cells. This clearly excluded the possibility of malignant condition and nonmalignant diagnosis was considered. Moreover the patient also responded well to an antibiotic course after diagnosis of typhoid.3. Genetic studies were however not done as firstly it was not considered necessary in view of absolutely normal bone marrow and secondly also due to financial constraints.4. The Salmonella Typhi O antigen titre of 1: 160 dilution was considered positive and patient responded very well to course of antibiotics. Her clinical follow up was unremarkable and thus chance of any leukemic process was completely eliminated.5. The authors agree with the various hypotheses that have been enlisted by Yavaşoğlu and Bolaman for genesis of Auer rod in infectious conditions. In the background of these theories and findings, the presence of clear rod-like structure due to condensation of azurophilic granules in neutrophil in typhoid infection led to the consideration of Auer rod in nonmalignant condition.Thanking you,