Intracytoplasmic basophilic bodies in leukocytes in an HIV patient with pleural and pericardial effusion led to unexpected diagnosis

Abstract

Human immunodeficiency virus (HIV) infections are declining worldwide; however, there are still >1.2 million HIV-infected people in the USA and ~6700 deaths/year can be directly attributed to HIV-related diseases. Opportunistic infections, Kaposi sarcoma, and non-Hodgkin lymphomas are always high in the differential diagnosis of HIV patients with systemic symptoms; however, causes of morbidity and mortality in HIV patients on highly active antiretroviral therapy are now approaching those of the general population. We present a case of an HIV patient who presented with B symptoms and body effusions. Diagnostic work-up geared towards infectious and neoplastic diseases led to the identification of intra- and extracellular rounded basophilic bodies in bone marrow and pleural effusion that were recognized as LE cells and allowed the diagnosis of systemic lupus erythematosus (SLE). We discuss the historical aspects of LE cell discovery, recent advances about their nature, ramifications of concurrent HIV-infection, and SLE and provide reference images of a finding that was originally described in bone marrow biopsies, but that nowadays has been nearly forgotten due to the development of alternative diagnostic tests.