PMC6529707_01
Histiocytes with intracytoplasmic RBC and WBC.
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Bone marrow biopsy for evaluation of cytopenia's demonstrated presence of histiocytes with intracellular RBC and WBC's (Fig. 1).
PMC6529707_02
Intracytoplasmic inclusions in the histiocytic appearing cells suspicious for Ehrlichiosis.
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Ehrlichiosis was suspected on the basis of a tick bite and the presence of morulae in the cytoplasm of a monocyte (Fig. 2).
PMC6529707_03
(A, B, C)- Bone Marrow biopsy GMS 40x: Special stain for GMS confirmed the presence of intracellular fungi consistent with Histoplasma capsulatum (A). Bone Marrow Aspiration 40x: A macrophage with intracellular fungi consistent with Histoplasma capsulatum (B). Histiocyte containing erythrocytes, lymphocytes, and a microorganism consistent with Histoplasma capsulatum (C).
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The biopsy showed pancytopenia, increased iron stores, extensive intracytoplasmic fungi consistent with histoplasmosis and hemophagocytosis (Fig. 3).