Budding Yeast Forms on Peripheral Blood Smear: An Intriguing Finding

Excerpt

54 year old female, case of metastatic carcinoma breast presented to the emergency in semi-comatose state. Investigations revealed normal renal and mildly deranged liver functions. Hemogram done from central line sample showed Hb 9.7 of g%, neutrophilic leukocytosis and adequate platelets. Peripheral blood smear (PBS) showed numerous intracellular (within neutrophils and monocytes) yeast forms (Fig. 1) which were morphologically difficult to differentiate from histoplasma species. The organisms were positive for PAS and Gomori methenamine silver (GMS) stain and negative for mucicarmine & India ink preparation. Fresh blood and tracheal secretion culture revealed yeast within 24 h of incubation. Subculture streaking revealed dry, dull creamy white heaped up colonies of Candida. Identification was done on Vitec-2 which revealed Candida tropicalis. The patient succumbed to her metastatic disease and bacterial sepsis developing during ICU stay 7 days later.

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