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Yeast-like intraleukocytic inclusions in a peripheral smear

Yeast-like intraleukocytic inclusions in a peripheral smear
#00012697
Author: Lars F. Westblade and Carey-Ann D. Burnham
Category: Infectious Disease > Fungi > Candida
Published Date: 10/29/2012

A 17-year-old male with short gut syndrome secondary to Hirschprung disease presented with a 2-week history of night sweats. He had an indwelling central line for total parental nutrition (TPN) supplementation and a history of multiple line infections with a variety of organisms. After completing a 10-day course of prophylactic fluconazole, and 1 week before the onset of night sweats, he had 4 teeth extracted. Complete blood count showed a leukocyte count of 4.0 × 103/mL (73% neutrophils) and the peripheral blood smear revealed neutrophils with brilliant blue–colored yeast-like intraleukocytic organisms, 2 to 4 µm in diameter (see figure, Wright-Giemsa). The organisms had neither the pseudocapsule or eccentric chromatin suggestive of Histoplasma capsulatum; nor did they produce the “collarettes” indicative of the phialides of Malassezia furfur, a lipid-dependent yeast associated with fungemia in patients requiring TPN. Subsequently, blood cultures grew Candida glabrata.