Silverman J F, Holter J F, Berns L A, Benning T L, Neill J S
Department of Pathology and Laboratory Medicine, East Carolina University School of Medicine, Greenville, NC 27858-4354.
Diagn Cytopathol. 1993 Oct;9(5):534-9; discussion 539-40. doi: 10.1002/dc.2840090512.
"Negative images" of bacilli in mycobacterial infections have been recently described in air-dried, Romanovsky-stained cytologic material. We report a case of negative images due to crystalline deposition of clofazimine, a drug used to treat Mycobacterium avium-intracellulare complex infection in AIDS patients. The negative images of clofazimine crystals seen in bronchoalveolar lavage (BAL) macrophages resemble the negative images of mycobacterial infection due to the pseudogaucher appearance of the cells. Crystals are distinguished by their refractile reddish appearance in unfixed, unstained smears, and by their birefringence on polarization. Crystals were found in both Pap-stained and Diff-Quik-stained smears and were negative with Ziehl-Neelsen stains. Clofazimine crystals in BAL specimens must be distinguished from the pseudogaucher type cells of mycobacterial infection in this patient population. We believe that this is the first report of clofazimine crystal deposition diagnosed in a BAL specimen along with electron microscopic examination of the cytologic material.
分枝杆菌感染中杆菌的“阴性图像”最近在风干、罗曼诺夫斯基染色的细胞学材料中被描述。我们报告了一例因氯法齐明结晶沉积导致的阴性图像病例，氯法齐明是一种用于治疗艾滋病患者鸟分枝杆菌复合群感染的药物。在支气管肺泡灌洗（BAL）巨噬细胞中看到的氯法齐明晶体的阴性图像，由于细胞的假高雪氏外观，类似于分枝杆菌感染的阴性图像。晶体在未固定、未染色的涂片中呈现可折射的微红外观，在偏振光下具有双折射性，以此可加以区分。在巴氏染色和Diff-Quik染色涂片中均发现了晶体，且齐-尼氏染色呈阴性。在该患者群体中，BAL标本中的氯法齐明晶体必须与分枝杆菌感染的假高雪氏型细胞区分开来。我们认为，这是第一份在BAL标本中诊断出氯法齐明晶体沉积并对细胞学材料进行电子显微镜检查的报告。
