PMC6010963_01
A: Non-blanching petechia on lower extremities: The clinical exam within hours of admission. B: Peripheral Blood Smear: A phagocytic histiocyte engulfing Histoplasma yeast on day 3. C: Chest radiograph on admission: Bilateral ground glass reticulo-nodular infiltrates that eventually progressed to acute respiratory distress syndrome.
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Mild scleral icterus and non-blanching petechiae on his lower extremities and torso were present (Fig. 1A). The initial blood smear was negative for malaria but revealed possible intracellular yeast without any characteristic morphology; Micafungin was added (Fig. 1B). Serial chest radiography revealed worsening diffuse bilateral alveolar infiltrates (Fig. 1C). Given worsening bilateral alveolar infiltrates (Fig. 1C), ARDS protocol was initiated.