#00063701

A 31-year old female with clinical history of HIV infection, presented with skin ulcers on arms, legs, and pancytopenia. Her CD4 count was 1. A bone marrow biopsy was performed to rule out HIV related malignancies and infections.  Skin biopsy showed viral infection compatible with herpes simplex virus (HSV), while the bone marrow biopsy showed markedly reduce trilineage hematopoiesis, but extensive poorly formed non-necrotizing granulomas and foamy histiocytes containing negative stained filamentous material (image A, 100x). Bone marrow aspirate smears reveal many histiocytes filled with negative imprints on Wright-Giemsa stain (image a, inset). Special stains of AFB (image B, 100x) and FITE highlight acid fast mycobacteria compatible with mycobacterium avium-intracellulare complex (MAC), which were also visible by PAS-D (image C, 100x) and GMS stains (image D, 100x). Overall, this is a wide disseminated MAC infection in a stage 4 AIDS patient.