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A 28-year old man with HIV/AIDS presented to the emergency with fever for the past ten days.

Examination revealed hepato-splenomegaly and lymphadenopathy. Blood investigations showed

hemoglobin of 70 g/L, white cell count of 3.4x10^9/L and platelet count of 30x10^9/L. CD4+ T-cell count

was 0.04x10^9/L. Peripheral blood smear examination confirmed pancytopenia; careful examination

revealed a few monocytes showing intracellular yeast like organisms with an eccentric nucleus and a

“capsule-like” structureinside the cytoplasm (Fig, Panel A&B: Peripheral blood smear, Jenner-Giemsa stain,

100x objective, original magnification x1000, arrows).Bone marrow aspirate and biopsy [Panel C (Jenner-

Giemsa) &D (Hematoxylin & eosin), 100x objective, original magnification x1000, arrows] performed

later showed numerous macrophages with intracytoplasmic Histoplasma capsulatum. Giemsa (Panel E, 100x objective, original magnification x1000) & Gomori’s methenamine silver (Panel F, 100x objective,

original magnification x1000) stains confirmed the same. Antifungal therapy was started but

unfortunately he succumbed to the disease.

This case apart from its rarity highlights the importance of a careful peripheral blood smear

examination for micro-organisms within leukocytes for prompt initiation of appropriate therapy.