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A 60-year-old man from an area endemic for leishmaniasis presented with 2 months of fever and hepatosplenomegaly. He had normal complete blood counts and negative blood and urine cultures. Chest x-ray revealed miliary shadows in both lung fields. A transbronchial lung biopsy showed granulomata with tubercle bacilli.
A bone marrow biopsy, performed as part of an assessment for fever, was normocellular with normal hematopoietic cell lines. However, while screening the marrow for Leishman-Donovan bodies, a few microfilariae were seen (shown). These were identified as Wuchereria bancrofti by the presence of a hyaline sheath, elongated terminal nuclei, length of cephalic space, and the pointed posterior end without terminal or subterminal swellings. On wet mount preparation, the filamentous translucent organisms exhibited brisk motility. Scanty microfilariae were seen on reviewing the blood film. Treatment for tuberculosis and filariasis was initiated.
Tropical pulmonary eosinophilia is usu
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