The correct answer is option 4. Heatstroke
The cells depicted are neutrophils (A-D), lymphocytes (E) and monocytes (F) with botryoid nuclei, characterized by hypersegmented nuclei with a radial arrangement. These were first seen in 1980 in six patients with heatstroke and were named after the Greek term “botrys,” which translates onto “bunch of grapes” because of their resemblance. Since then, they have been described in other conditions causing severe hyperthermia, such as cocaine and methamphetamine abuse, autoimmune limbic encephalitis, sepsis, drug rash with eosinophilia and systemic symptoms (DRESS) and neuroleptic malignant syndrome. These nuclear changes have been hypothesized to be early stages of oncotic (karyolysis) and apoptotic (karyorhexis and pyknosis) cell death because of extreme heat.
Reference:
- Verdú G, Vallvé M, San-José P, Molina A, Merino A. Diagnostic Value of Botryoid Nuclei as a Biomarker of Severe Hyperthermia and Systemic Inflammation in Heatstroke and Neuroleptic Malignant Syndrome: A Challenge of Climate Change. Int J Lab Hematol. May 2025. doi:10.1111/ijlh.14500
- Chiriac R, Pourchet V. Noyaux botryoïdes des leucocytes induits par le syndrome de DRESS. Ann Biol Clin (Paris). 2025;83(2):220-222. doi:10.1684/abc.2025.1961
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