Jaundice with severe leucocytosis

A 36-year-old Hispanic woman was admitted to the emergency department with jaundice, abdominal pain and fatigue. The patient reported daily alcohol consumption (70 units per week). Physical examination revealed jaundice, hepatosplenomegaly, high BMI (30 kg/m2) and significant bilateral oedema of the lower limbs. Complete blood count showed a severe leucocytosis with neutrophilia (white blood cell count at 48,000/μl including 85% neutrophils) associated with bicytopenia (haemoglobin at 4.3 g/dl and platelet count at 87,000/μl).