PMC9812595_01
Initial bone marrow aspiration showing myelodysplasia syndrome (MDS) with refractory cytopenia with multilineage dysplasia (RCMD) subtype and infection with H. capsulatum inside the macrophages (taken 2 weeks after admission and as the initial point to start antifungal treatment).
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The result was a myelodysplasia syndrome (MDS) with a refractory cytopenia multilineage dysplasia (RCMD) subtype and infection with Histoplasma capsulatum (Figure 1).
Bone marrow aspiration after 4 weeks of antifungal treatment showed the reduction of intracellular budding yeast of Histoplasma inside the macrophages.
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The sequential BMA revealed a gradual loss leading to complete clearance of H. capsulatum within ten weeks of treatment (Figures 2 and 3).
Bone marrow aspiration after 10 weeks of antifungal treatment showed macrophages without Histoplasma.
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The sequential BMA revealed a gradual loss leading to complete clearance of H. capsulatum within ten weeks of treatment (Figures 2 and 3).
Improvement in peripheral blood parameters following treatment with an antifungal in case 1.
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The blood evaluation during treatment is shown in Figure 4.
PMC9812595_02
Large ecchymosis in the lower extremities.
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He presented with several large ecchymoses in his lower extremities and trunk (Figure 5).
Bone marrow aspiration at the time of diagnosis showed Histoplasma capsulatum yeasts inside the macrophages.
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The BMA smear showed hemophagocytic lymphohistiocytosis (HLH) with abundant H. capsulatum inside the macrophage cells with dyserythropoiesis and dysgranulopoiesis (Figure 6).
Histoplasma capsulatum yeast in methylene blue (a) and KOH (b) staining taken 5 weeks after starting BMA culture in Sabouraud agar.
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The isolate was subsequently taken after 5 weeks and stained with methylene blue and KOH (Figure 7).
Improvement in peripheral blood parameters following treatment with an antifungal in case 2.
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The blood evaluation during treatment is shown in Figure 8.