#00066679

A 55-year-old woman with multisystem sarcoidosis receiving immunosuppressive therapy with methotrexate, infliximab, and prednisone presented with fever, jaundice, and severe pancytopenia. Her clinical course was complicated by marked hyperferritinemia, hepatosplenomegaly, hypofibrinogenemia, hypertriglyceridemia, and hepatic dysfunction, raising suspicion for secondary hemophagocytic lymphohistiocytosis (HLH). Peripheral blood smear examination revealed intracellular yeast forms morphologically compatible with Histoplasma capsulatum, supporting the diagnosis of disseminated histoplasmosis. Liposomal amphotericin B was initiated.

Peripheral blood smear showing multiple intracellular yeast forms within neutrophils. The organisms are small, round to oval, and demonstrate a basophilic appearance with surrounding clear halos, morphologically compatible with Histoplasma capsulatum.