Infection with normal WBC

Patient had sudden onset infection (15minutes). Diagnosed cellulitis in rt leg. WBC is 8.3. and has remained stable over 72 hrs. Received Vancomycin for 48hrs, fever persisted. Varies from 102-104.4
Added Zosyn. Fever is starting to break.
Patient has a history of 8 episodes of cellulitis over 20yrs. Current, active Aspergillosis infection in lungs. Fungal ball present. When infection hit O2 fell to 62.
How can he have a normal WBC? What could be the issue? Neuropathy in both legs from knees down. Charcot foot in left ft. NOT diabetic.
Dr.'s are stumped. Any ideas?
Is this your patient? Has ID been consulted?

ID is on board. Followed by ID for lungs. ID from hospital is on. They have no answers. He is confusing them.

Quote from Lisa HaneyID is on board. Followed by ID for lungs. ID from hospital is on. They have no answers. He is confusing them.

Immune compromised? HIV? Viral as opposed to bacterial? A fungal infection may not be bacterial, and may not increase WBC?Hard to tell without whole picture, however, very interesting.Let us know what they find.

I've had pt's with infections and a normal WBC count. Look at the differential. Ask the infectious disease doctor and tell us what you find out.

blood work may be a late sign. If antibiotics started soon then could account for it. However, there has to be more to this story.

Is the differential WNL? Sed rate? What is his baseline? The 8.3 may be an elevation for him.