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Disseminated coccidioidomycosis in bone marrow

A 29 year old previously healthy Chinese-American man presented with progressive respiratory failure and hepatosplenomegaly. Initial white count was 21.9 10/L, hemoglobin 9.3 g/dL, and platelets 60 10/L. On automated differential, 21% eosinophils were noted. The working diagnosis was hypereosinophilic syndrome. On evaluation of his bone marrow ( 10 on left and 100 on right, Image left and right), coccidioidomycosis spherules (refractile double-walled bodies that contain endospores) were clearly visible (red rectangles). (Image left and right) There was no evidence for an increased blast population and no evidence for a B-cell or T-cell lymphoproliferative disorder by flow cytometry. Received: 9 May 2021 Revised: 13 May 2021 Accepted: 14 May 2021