12. Cultures and stains performed on bone marrow and esophagus
Bone marrow figure:
Bone marrow biopsies from post-transplant, immunocompromised patients are evaluated for the presence of primary marrow defects (eg. drug induced cytopenias), infiltrative processes (eg. metastatic carcinoma and epstein-barr virus-related post-transplant lymphoproliferative disorder), and opportunistic infections (eg. fungal, viral, mycobacterial). Although the bone marrow biopsy from this patient is insufficient to assess hematopoiesis, numerous loose collections of foamy macrophages were identified. Special stains for acid fast bacilli [inset] revealed the presence of abundant mycobacteria. Given the clinical history and the number of mycobacteria seen, this finding supports the diagnosis of infection with mycobacterium avium complex (MAC).
Esophageal ulcerations in immunocompromised individuals are assessed for the presence of opportunistic infections including: candida, herpes simplex virus, and cytomegalovirus. A biopsy taken from this patient shows ulceration of the squamous mucosa with an underlying collection of foamy histiocytes. Special stains for acid fast bacilli [inset] show numerous mycobacteria. Taken together with the bone marrow biopsy, these findings suggest disseminated infection with MAC.