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case_images: A CT scan of chest and abdomen on the day of admission. A mild inflammation was seen in the lower lobes of bilateral lungs, and the liver was slightly enlarged.
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case_images: A CT scan of chest and abdomen showed mild inflammation in the lower lobes of bilateral lungs, and the liver was slightly enlarged (Figure 1).
case_images: Histoplasma capsulatum (numerous, capsulated yeast cells) of phagocyte cells (arrow) in bone marrow smear (Wright's staining, magnification 1,000x).
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case_images: However, Wright-stained bone marrow aspirates revealed intracellular oval or spherical yeast-like cells, which was highly suggestive of H. capsulatum (Figure 2), with normal number and classification of megakaryocytes.
case_images: (a, b) Yeast-like spores and hyphae (with an arrow, gram staining, magnification 1,000x) under microscopy with bone marrow cultured at 37  C in 16 days. (c, d) Colonies grown at 28  C and 37  C with bone marrow bone cultured in 16 days; (c) White, short villous and filamentous colonies; (d) Yeast-like colonies. (e, f) Fungal morphology under microscopy by taking colonies, respectively; (e) A filamentous form with tuberculate macroconidia on the septate hyphae (lactic acid phenol cotton blue staining); (f) Yeast-like fungus, budding cells with pseudohyphae (gram staining).
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case_images: Interestingly, yeast-like cells and hyphae were seen in the smears (Figure 3a-b). which were compatible with Histoplasma spp., then we inoculated the culture specimen on the Sabouraud Dextrose Agar (SDA), incubated at 28  C and 37  C, respectively, in 9 days later, it appeared cottony white colonies under culture condition at 28  C and a yeast-like colony at 37  C (Figure 3c-d). Microscopic examination showed tuberculate macroconidia and the septated hyphae, and budding cells and pseudohyphae under microscopic (Figure 3e-f).