The following images are from a Papanicolaou-stained bronchoalveolar lavage obtained from a 70 year old man with increasing respiratory distress. His medical history is significant for hemodialysis-dependent end-stage renal disease and vasculitis (treated with cytoxan).
Diagnosis? (CLICK ON IMAGES TO ENLARGE)
Any thoughts on what the last image represents?
x400 original magnification
![](//3.bp.blogspot.com/--V88mGwVeIg/TsEp5Khr3pI/AAAAAAAAByY/BXrsO56CITU/s400/bp1x400.JPG)
x600 original magnification
![](//1.bp.blogspot.com/-VIMpAnBwHFA/TsEp6Em92sI/AAAAAAAABzA/BGg003HEA7s/s400/bp%2Bbig%2Bguy%2B400x.JPG)
![](//4.bp.blogspot.com/-r6r_T9gh0bE/TsEp536B1ZI/AAAAAAAAByw/36QAvTlY4bQ/s400/bp3.JPG)
![](//2.bp.blogspot.com/-mg7hzyMt5po/TsEp5W1p9NI/AAAAAAAAByo/Uy1p1_Fp0II/s400/bp1x600.JPG)
![](//4.bp.blogspot.com/-2ZtetO8XFvQ/TsEp6kBW2II/AAAAAAAABzI/gPhBvFu51js/s400/bp6x600.JPG)
![](//4.bp.blogspot.com/-9vHUM3G1Uxg/TsEqAgf6-BI/AAAAAAAABzU/EcvCIVSvTbc/s400/schmutz5mm.JPG)
Many thanks to Dr. Steven Goodman for donating this case!