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Central Nervous System (CNS) Toxoplasmosis

This image represents a cerebrospinal fluid (CSF) cytospin preparation from a patient who recently received a bone marrow transplant for recurrent central nervous system (CNS) Burkitt lymphoma. The patient was admitted to the hospital two weeks after transplant due to rapidly altering mental status.

When the CSF demonstrated a high white blood cell (WBC) count, the first concern was a possible CNS relapse of the Burkitt lymphoma. However, the cytospin showed many neutrophils in spite of the patient's peripheral blood neutropenia. No malignant cells were identified.

On closer examination of the neutrophil clusters, ovoid inclusions were noted (see arrow) as well as free banana-shaped organisms (see circled area). The ovoid inclusions in the neutrophils and the free forms have lavender cytoplasm with a centrally placed cluster of reddish granules.