PMC6371201_01
Wright-Giemsa stained smear of peripheral blood containing classic hairy cells - medium size lymphocytes with moderately abundant pale blue cytoplasm and a characteristic serrated cytoplasmic border.
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A bone marrow aspirate was also performed, which demonstrated 36% of lymphoid cells with morphology resembling hairy cells (Figure 1).
Thoracic computed tomography - bilateral pulmonary opacities in a "crazy paving" pattern compatible with severe acute respiratory distress syndrome.
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A week after the diagnosis, despite the use of broad-spectrum antibiotics (piperacillin/tazobactam and vancomycin), his general condition deteriorated, with significant worsening of the dyspnea, persistent fever, and then the patient progressed to septic shock of pulmonary origin associated with ARDS and acute renal injury requiring hemodialysis (Figure 2).