A case of systemic histoplasmosis diagnosed in a peripheralblood smear

A 34-year-old female from Ohio, 1Æ5 years post-kidney–

pancreas transplantation for diabetic nephropathy was referred

to exclude transplant rejection. She had developed slight fever

and increasing creatinine levels in the days prior to hospital-

ization, but was in otherwise good general condition. Physical

examination was unremarkable; blood and urine samples were

sent for culture. Antibiotics were started empirically and a

kidney biopsy showed moderate acute rejection. One week

after increasing the dose of tacrolimus, her renal function

deteriorated rapidly and she developed septic shock. Until that

point all cultures had been negative. A peripheral blood smear,

submitted on day 8 of hospitalization, for assessment of

anaemia, confirmed the presence of microangiopathic haemo-

lysis; in addition there were numerous intracytoplasmic yeast-

like organisms within neutrophils and monocytes (top,

Wright–Giemsa; bottom left, Gomori’s methenamine silver).

Blood samples were sent to the microbiology laboratory where

a diagnosis of Histoplasma capsulatum infection was estab-

lished by morphology and culture and confirmed by a specific

DNA probe. The patient died later the same day. Autopsy

examination revealed systemic histoplasmosis (bottom right,

section of spleen showing sinusoidal histiocytes containing

histoplasma, Gomori’s methenamine silver stain).

Hector Mesa

Stefan Pambuccian

Patricia Ferrieri

Richard Brunning

Department of Laboratory Medicine and Pathology, University of

Minnesota School of Medicine, Minneapolis, MN, USA.

E-mail: mesa0013@umn.edu

images in haematology

ª 2004 Blackwell Publishing Ltd, British Journal of Haematology, 127, 241 doi:10.1111/j.1365-2141.2004.05164.x