An HIV+ 50 year old male nurse presented with a history of flank pain, fever, pancytopenia, weight loss, and nephrolithiasis.  His CD4 count was less than 20; the CD4/CD8 ratio was 0.1.  A bone marrow biopsy showed marrow hypercellularity, reticulin fibrosis, and megakaryocytic hyperplasia, but no evidence of lymphoid neoplasia.  Ascites and lower extremity edema developed, and a sample of ascitic fluid was obtained by paracentesis.  Flow cytometric analysis of the ascitic fluid was performed at a well-known reference laboratory, and reported as, “Marked decrease in CD4 lymphocytes; no immunophenotypic evidence of non-Hodgkin’s lymphoma.”

The following images are from the smears and cell block preparations of the ascitic fluid.

Atypical Ascites Fluid

CD 20


CD 3


CD 30


CD 138

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