Bone marrow necrosis related to paracoccidioidomycosis: the first eight cases identified at autopsy

Abstract

Aims: To report the first eight bone marrow necrosis (BMN) cases related to paracoccidioidomycosis (PCM) from patient autopsies with well-documented bone marrow (BM) histology and cytology.

Methods and results: A retrospective evaluation was performed on BM specimens from eight autopsied patients from Botucatu University Hospital with PCM-related BMN. Relevant BMN literature was searched and analysed.

Conclusions: All eight patients had acute PCM. Six had histological only (biopsies) and two cytological only (smears) specimens. Five biopsy specimens revealed severe and one mild coagulation patterned necrotic areas. Five had osteonecrosis. The cytological specimens also showed typical BMN patterns. Paracoccidioides brasiliensis yeast forms were visible within necrotic areas in all cases.

Figure 1

A, Case 1: Severe coagulative bone marrow necrosis (BMN) in an AIDS patient. Fungal cells can be observed within the ghosts of the dead hematopoietic cells (arrows). Bone marrow biopsy (BMB); H&E. B, Case 2: Extensive coagulative BMN. Bone trabecula was also affected (arrow). BMB; H&E. C, Case 5: Disarrangement of bone marrow architecture due to both parenchymal and trabecular severe BMN. BMB; H&E. D, Case 6: Necrotic bone trabecula in an extensive area of granulomatous reaction presenting numerous Paracoccidioides brasiliensis. Remnant of non-necrotic bone can be seen on its upper border (arrows). BMB; H&E. E, Case 7: Necrotic hematopoietic cells with a smudgy appearance. A stained smooth homogeneus background precipitate is present. Fungal cells can be seen (arrows). Aspirated smear; Giemsa. F, Case 8: Typical coagulative necrosis on aspirated smear. An agglomerate of histiocyte attempts to form a giant cell (arrow). Several P. brasiliensis are also present. Aspirated smear; Shorr.