Contributed by Chris Gilbert, MD and Nadia Habib-Bein, MD, PhD
A 25 year-old male presents with high fever (105 degrees F) for approximately one week, accompanied by nausea, vomiting, arthralgias, and myalgias. He reports that he spent the past 15 months serving with the military in Afghanistan and only recently returned. He had been taking mefloquine for malarial prophylaxis but discontinued it several weeks-months ago.
He hands to the emergency department personnel a bag of 800ccs of amber-colored urine.
In the hospital, testing revealed the following findings:
A blood sample was sent for evaluation to hematopathology. The following images were taken at 100X: