From www.bloodjournal.org by guest on September 11, 2016. For personal use only.
bloodwork ®
IMAGES
IN HEMATOLOGY
Curious beads for a clinical pearl
c Julien Decker and Jean Franc‚ois Lesesve, Centre Hospitalier Universitaire de Nancy
A
42-year-old man was diagnosed with a severe acute respiratory distress syndrome following inhalation of his stomach contents. The previous history revealed liver cirrhosis due to alcoholic liver disease. Seven days later, he presented with a high fever and a painful abdominal distension due to ascites. The blood cell count was as follows: hemoglobin, 10.9 g/dL; white blood cells, 12.230 3 109/L (neutrophils, 9.124 3 109/L); and platelets, 124 3 109/L. The ascitic fluid analysis showed total nucleated cells of 0.242 3 109/L (neutrophils, 29%; lymphocytes, 9%; monocytes, 53%; peritoneal cells, 9%). Microscopic examination showed a mix of isolated, clumped, and budding “pearls” inside or outside the macrophagic cells (panel A). The yeasts had been phagocytized by neutrophils, macrophages, and peritoneal cells and sometimes were arranged as a ring in their cytoplasm (panels B-E). They were identified as Candida albicans, and similar yeasts were identified in the tracheal aspirate. In conjunction with the management of the whole disorder, the patient received fluconazole through an intravenous catheter and recovered after weeks. Candida sp. infections are well documented in immunocompromised patients. In such a context, the infection is not always accompanied by increased neutrophils in the blood or in the ascitic fluid. Peritoneal cells are capable of phagocytizing microorganisms as neutrophils and monocytes/macrophages do.
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 3666
BLOOD, 4 DECEMBER 2014 x VOLUME 124, NUMBER 24
From www.bloodjournal.org by guest on September 11, 2016. For personal use only.
2014 124: 3666 doi:10.1182/blood-2014-08-596213
Curious beads for a clinical pearl Julien Decker and Jean François Lesesve
Updated information and services can be found at: http://www.bloodjournal.org/content/124/24/3666.full.html Articles on similar topics can be found in the following Blood collections BloodWork (465 articles) Free Research Articles (4041 articles) Immunobiology (5415 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
Curious beads for a clinical pearl
c Julien Decker and Jean Franc‚ois Lesesve, Centre Hospitalier Universitaire de Nancy
A
42-year-old man was diagnosed with a severe acute respiratory distress syndrome following inhalation of his stomach contents. The previous history revealed liver cirrhosis due to alcoholic liver disease. Seven days later, he presented with a high fever and a painful abdominal distension due to ascites. The blood cell count was as follows: hemoglobin, 10.9 g/dL; white blood cells, 12.230 3 109/L (neutrophils, 9.124 3 109/L); and platelets, 124 3 109/L. The ascitic fluid analysis showed total nucleated cells of 0.242 3 109/L (neutrophils, 29%; lymphocytes, 9%; monocytes, 53%; peritoneal cells, 9%). Microscopic examination showed a mix of isolated, clumped, and budding “pearls” inside or outside the macrophagic cells (panel A). The yeasts had been phagocytized by neutrophils, macrophages, and peritoneal cells and sometimes were arranged as a ring in their cytoplasm (panels B-E). They were identified as Candida albicans, and similar yeasts were identified in the tracheal aspirate. In conjunction with the management of the whole disorder, the patient received fluconazole through an intravenous catheter and recovered after weeks. Candida sp. infections are well documented in immunocompromised patients. In such a context, the infection is not always accompanied by increased neutrophils in the blood or in the ascitic fluid. Peritoneal cells are capable of phagocytizing microorganisms as neutrophils and monocytes/macrophages do.
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 3666
BLOOD, 4 DECEMBER 2014 x VOLUME 124, NUMBER 24
From www.bloodjournal.org by guest on September 11, 2016. For personal use only.
2014 124: 3666 doi:10.1182/blood-2014-08-596213
Curious beads for a clinical pearl Julien Decker and Jean François Lesesve
Updated information and services can be found at: http://www.bloodjournal.org/content/124/24/3666.full.html Articles on similar topics can be found in the following Blood collections BloodWork (465 articles) Free Research Articles (4041 articles) Immunobiology (5415 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.
