case_images: PMC9425888_01
case_images: Necropsie and histopathology data: (A) Voluminous splenomegaly, with diffluent red flesh and numerous white nodules, (B) Coalesced lymph nodes forming an abscess in the peripancreatic region, (C) Extensive pulmonary hemorrhage (hematoxylin and eosin, 100x), (D) Fungal structures in peripancreatic lymph node compatible with Histoplasma sp. (Grocott, 400x), and (E) Splenic subcapsular macrophages phagocytizing red blood cells (hemophagocytosis) (black arrows). Inset, one of hemophagocytized macrophages (hematoxylin and eosin, 1000x magnification).
case_images: 10.1177_2632010X221118059-fig1.jpg
case_images: PMC9425888_01_10.1177_2632010X221118059-fig1.jpg
case_images: fig1-2632010X221118059
case_images: When cutting the spleen, numerous white nodules were noted, and these measured approximately 0.5 cm throughout the splenic surface (Figure 1A). II and III, associated with macrovacuolar steatosis, were observed. In the peripancreatic region, numerous coalescent lymph nodes could be seen, which were concentrated by cavitation containing purulent material (Figure 1B), and microscopy portrayed extensive areas of necrosis, surrounded by a lymphohistiocytic inflammatory infiltrate with a morphological pattern that was consistent with H. capsulatum (Figure 1C). Using Grocott's method, the staining showed the presence of small, uniformly oval, narrow-based budding yeasts with eccentric acorn-like nuclei compatible with Histoplasma sp., which were also found in the liver and spleen (Figure 1D). In the latter, extensive areas of necrosis were observed, from permeation to congestion and, in the subcapsular area, the presence of red blood cells phagocytized by macrophages (Figure 1E).