From www.bloodjournal.org by guest on September 11, 2016. For personal use only.
bloodwork ®
IMAGES
IN HEMATOLOGY
Bone marrow aspirate showing Penicillium marneffei
c Ning Han and Liang Wu, Beijing Ditan Hospital Capital Medical University
A
27-year-old HIV-infected male presented with a 1-month history of poor appetite, cough, low-grade fever, and diffuse rash involving the face and trunk. He lived in the city of Shenzhen in southern China near Hong Kong. He had not previously received antiretroviral therapy. He had pancytopenia with hemoglobin of 78.7 g/L, a total leukocyte count of 3.58 3 109/L, and a platelet count of 96 3 109/L. The alanine transaminase was elevated at 52.5 U/L. Abdomen ultrasonography showed ascites and lymphadenopathy in the hepatic hilar region without hepatosplenomegaly. The clinical suspicion was disseminated penicilliosis. Bone marrow aspiration and culture were performed. Bone marrow aspirate showed yeastlike organisms in the bone marrow. The organisms were elongated with a characteristic clear central septation, morphologically consistent with Penicillium marneffei (recently renamed Talaromyces marneffei). The blood culture later grew P marneffei, but bone marrow culture was negative. P marneffei was identified with 2 different thermal morphologies, by the mold form in cultures grown at 25°C and yeast form at 37°C. The patient was diagnosed with disseminated penicilliosis. Oral itraconazole was administered with clinical response. Bone marrow aspirate and culture can speed the diagnosis of disseminated penicilliosis. To ensure successful antifungal treatment, timely diagnosis is important.
For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit http://imagebank.hematology.org. © 2014 by The American Society of Hematology BLOOD, 4 SEPTEMBER 2014 x VOLUME 124, NUMBER 10
1689
From www.bloodjournal.org by guest on September 11, 2016. For personal use only.
2014 124: 1689 doi:10.1182/blood-2014-06-580589
Bone marrow aspirate showing Penicillium marneffei Ning Han and Liang Wu
Updated information and services can be found at: http://www.bloodjournal.org/content/124/10/1689.full.html Articles on similar topics can be found in the following Blood collections BloodWork (465 articles) Free Research Articles (4041 articles) Hematopoiesis and Stem Cells (3360 articles) Information about reproducing this article in parts or in its entirety may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#repub_requests Information about ordering reprints may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#reprints Information about subscriptions and ASH membership may be found online at: http://www.bloodjournal.org/site/subscriptions/index.xhtml
Blood (print ISSN 0006-4971, online ISSN 1528-0020), is published weekly by the American Society of Hematology, 2021 L St, NW, Suite 900, Washington DC 20036. Copyright 2011 by The American Society of Hematology; all rights reserved.
bloodwork ®
IMAGES
IN HEMATOLOGY
Bone marrow aspirate showing Penicillium marneffei
c Ning Han and Liang Wu, Beijing Ditan Hospital Capital Medical University
A
27-year-old HIV-infected male presented with a 1-month history of poor appetite, cough, low-grade fever, and diffuse rash involving the face and trunk. He lived in the city of Shenzhen in southern China near Hong Kong. He had not previously received antiretroviral therapy. He had pancytopenia with hemoglobin of 78.7 g/L, a total leukocyte count of 3.58 3 109/L, and a platelet count of 96 3 109/L. The alanine transaminase was elevated at 52.5 U/L. Abdomen ultrasonography showed ascites and lymphadenopathy in the hepatic hilar region without hepatosplenomegaly. The clinical suspicion was disseminated penicilliosis. Bone marrow aspiration and culture were performed. Bone marrow aspirate showed yeastlike organisms in the bone marrow. The organisms were elongated with a characteristic clear central septation, morphologically consistent with Penicillium marneffei (recently renamed Talaromyces marneffei). The blood culture later grew P marneffei, but bone marrow culture was negative. P marneffei was identified with 2 different thermal morphologies, by the mold form in cultures grown at 25°C and yeast form at 37°C. The patient was diagnosed with disseminated penicilliosis. Oral itraconazole was administered with clinical response. Bone marrow aspirate and culture can speed the diagnosis of disseminated penicilliosis. To ensure successful antifungal treatment, timely diagnosis is important.
For additional images, visit the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas and case study images. For more information visit http://imagebank.hematology.org. © 2014 by The American Society of Hematology BLOOD, 4 SEPTEMBER 2014 x VOLUME 124, NUMBER 10
1689
From www.bloodjournal.org by guest on September 11, 2016. For personal use only.
2014 124: 1689 doi:10.1182/blood-2014-06-580589
Bone marrow aspirate showing Penicillium marneffei Ning Han and Liang Wu
Updated information and services can be found at: http://www.bloodjournal.org/content/124/10/1689.full.html Articles on similar topics can be found in the following Blood collections BloodWork (465 articles) Free Research Articles (4041 articles) Hematopoiesis and Stem Cells (3360 articles) Information about reproducing this article in parts or in its entirety may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#repub_requests Information about ordering reprints may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#reprints Information about subscriptions and ASH membership may be found online at: http://www.bloodjournal.org/site/subscriptions/index.xhtml
Blood (print ISSN 0006-4971, online ISSN 1528-0020), is published weekly by the American Society of Hematology, 2021 L St, NW, Suite 900, Washington DC 20036. Copyright 2011 by The American Society of Hematology; all rights reserved.
