PMC9287149_01
(A-C). Bone marrow aspirate smear from Patient 1 showing macrophages (arrow) in adjacent fields with numerous intracellular inclusions but no identifiable or clearly-associated kinetoplast-like structures. Hematoxylin-eosin stain; original magnification, x1000.
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In addition to containing ingested erythrocytes, bone marrow macrophages (histiocytes) also showed numerous intracellular inclusions (Fig. 1).
PMC9287149_02
Colonic biopsy tissue (A) and bone marrow aspirate smear (B) from Patient 2. In (A), arrows indicate two amastigotes with identifiable kinetoplasts. Note adjacent "nest" of forms (arrowhead) possibly resembling a T. cruzi "pseudocyst." In (B), arrows indicate characteristic Leishmania amastigote morphology in extracellular forms released during smear preparation. Hematoxylin-eosin (A) and Wright-Giemsa (B) stains; original magnification, x1000.
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Autopsy was not permitted, but a histopathology slide from the original colonic biopsy 3 months before was subsequently provided and reviewed (Fig. 2).