IMAGES IN CYTOLOGYSection Editor: Shahla Masood, M.D.

Cytodiagnosis of SimultaneousPulmonary Infection Due toCytomegalovirus andPneumocystis Carinii in a Sampleof Bronchoalveolar LavageRaj K. Gupta, M.D., F.I.A.C.,* Sarla Naran, B.Sc, C.F.I.A.C.,Sharda Lallu, B.Sc., C.F.I.A.C., and Robert Fauck, C.T. (I.A.C.)

Pulmonary infections are caused by a wide variety of organismsand the findings of these in cytologic samples of the respiratorytract can be of diagnostic significance. A 34-year-old male onimmunosuppresive therapy due to progressive renal impairmentand nephrotic syndrome was admitted with cough and progressiveshortness of breath. An X-ray of the chest showed lung infiltratesindicative of pneumonitis. Bronchoalveolar lavage (BAL) wasdone, and cytologic examination of Papanicolaou-stained filterpreparations showed pneumocytes infected with cytomegalovirus(CMV) characterized by large, dense, central smooth nuclearinclusions surrounded by clear (halo) zone in individual cells (Fig.C-1A). Additionally, pneumocystis carinii (PCP) was found anddisplayed cyanophilic/purplish frothy, foamy to bubbly exudatecorrosponding to alveolar material with the organisms, whichwere further defined in a cell block preparation of BAL sample asspherical, cup-shaped, crescent-shaped, or with crinkled capsuleswith Gomori’s silver methenamine (GMS) stain (Fig. C-1B). Thecytodiagnosis of CMV and PCP infection was immediately ren-dered and was later also confirmed on microbiologic testing.

Since medical decisions in patients with pulmonary infec-tions, and especially with an immunocompromised status, arequite essential to determine which organisms are clinicallysignificant for an assessment of the infectious agent, the use ofBAL for a diagnosis in recent years has become quite commonand seems to be a very useful modality, virtually replacing lungbiopsy in the majority of cases. The case presented here alsoseems to attest to this fact.

Cytology Unit, Department of Laboratory Services, Wellington Hospitaland School of Medicine, Wellington, New Zealand

*Correspondence to: Raj K. Gupta M.D., F.I.A.C., Cytology Unit, Well-ington Hospital, Wellington, New Zealand. E-mail: raj.gupta@xtra.co.nz

Received 7 July 2003; Accepted 30 October 2003DOI 10.1002/dc.20029Published online in Wiley InterScience (www.interscience.wiley.com).

Fig. C-1. A: CMV in BAL sample showing a cell with dense centralnuclear inclusion surrounded by clear (halo) zone (Papanicolaou stain�600, original magnification). B: PCP organisms in GMS-stained cellblock preparation of BAL sample in the above case (�600, originalmagnification).

© 2004 WILEY-LISS, INC. Diagnostic Cytopathology, Vol 30, No 5 341