PMC9795948_01
High resolution chest computed tomography showing bilateral solid nodules with ground glass halo (arrows). Source: Authors
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Fig1
Round, thick-walled conidia, with multibudding yeast cells ("Mickey Mouse ears"), compatible with Paracoccidioides brasiliensis. Grocott's silver methenamine stain, 40 x. Source: Authors
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Fig2
Ziehl-Neelsen stain and polymerase chain reaction assays for tuberculosis were negative, but the histopathologic study exhibited chronic necrotizing granulomatous inflammation, with large areas of liquefactive necrosis, containing Paracoccidioides brasiliensis yeasts (Figs. 2, 3).
Epithelioid histiocyte aggregate that constitute a granuloma with central caseating necrosis. H & E, 10 x Source: Authors
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Fig3
Ziehl-Neelsen stain and polymerase chain reaction assays for tuberculosis were negative, but the histopathologic study exhibited chronic necrotizing granulomatous inflammation, with large areas of liquefactive necrosis, containing Paracoccidioides brasiliensis yeasts (Figs. 2, 3).
Bone marrow flow cytometry reveals neutrophils (purple) and monocytes (yellow) lacking expression of cytoplasmic Myeloperoxidase. Eosinophils are depicted in pink, mature T lymphocytes in green (seafome green like), dendritic cells in green (lime green like) and residual T lymphoblast in red. Abbreviations: cyMPO, cytoplasmic Myeloperoxidase; FITC, fluorescein isothiocyanate; SSC-A, side scatter. Source: Authors
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Fig4
Regarding ALL, the treatment was resumed and after completion of the chemotherapy regimen, flow cytometry was performed in a bone marrow sample, which reported 0.4% of lymphoblasts, and MPO deficiency, depicted in Fig. 4, where flow cytometry shows different white cell populations as polymorphonuclear neutrophils and monocytes negative for MPO fluorescence, as an incidental finding as shown.