PMC2725836_01
Bone marrow examination of patient A bone marrow biopsy specimen showing numerous oval-shaped intracellular and extracellular microorganisms (A and B). A bone marrow aspiration smear showed numerous intracellular yeastlike microorganisms (C and D). A) hematoxylin and eosin stain, 1,000x; B), periodic acid-Schiff stain, 1,000x; C), Gram stain, 1,000x; and D), Wright stain, 1,000x.
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F1
Bone marrow aspiration (Figure 1) and biopsy were performed because of refractory thrombocytopenia and the presence of young blood cells on the peripheral blood smears.
A) Colony of the mold from the patient is white-brown with a cottony appearance on Sabouraud dextrose agar. B) Lactophenol Cotton Blue Stain (Hardy Diagnostics, Santa Maria, CA, USA) of the isolated mold showing thick-walled and tuberculate macroconidia (arrowheads) and microconidia (arrows). C) PCR assay for identification of Histoplasma capsulatum based on the nucleotide sequence of the M antigen. PCR products included 111-bp and 279-bp fragments amplified with primers Msp1F-Msp1R (pair 1) and Msp2F-Msp2R (pair 2), respectively, which confirmed the identification of H. capsulatum. M, molecular mass marker.
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F2
Four weeks later, the fungal culture of the bone marrow showed growth of mold (Figure 2A and B). The microorganism was subsequently identified as H. capsulatum by PCR assay (Figure 2C).