NEGATIVE IMAGES DUE TO CLOFAZIMINE CRYSTALS SIMULATING MAI INFECTION IN A BRONCHOALVEOLAR LAVAGE SPECIMEN

''Negative images'' of bacilli in mycobacterial infections have been r ecently described in air-dried, Romanovsky-stained cytologic materiaL We report a case of negative images due to crystalline deposition of c lofazimine, a drug used to treat Mycobacterium avium-intracellulare co mplex infection in AIDS patients. The negative images of clofazimine c rystals seen in bronchoalveolar lavage (BAL) macrophages resemble the negative images of mycobacterial infection due to the pseudogaucher ap pearance of the cells. Crystals are distinguished by their refractile reddish appearance in unfixed, unstained smears, and by their birefrin gence on polarization. Crystals were found in both Pap-stained and Dif f-Quik-stained smears and were negative with Ziehl-Neelsen stains. Clo fazimine crystals in BAL specimens must be distinguished from the pseu dogaucher type cells of mycobacterial infection in this patient popula tion. 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. (C) 1993 Wiley-Liss, Inc.