Spots and Dots

A 65-year-old woman with end-stage renal disease status post renal transplant 19 months ago was admitted with cough, fevers, and shortness of breath. Complete blood count (CBC) on admission showed the following: white blood cell (WBC) count, 1.41 K/mL; hemoglobin, 12.9 g/dL; mean corpuscular volume, 90 fL; and platelets, 163 K/mL. WBC differential was as follows: neutrophils, 55 percent; lymphocytes, including large granular forms, 30 percent; monocytes, 15 percent. Chest X-ray showed ill-defined patchy opacities in the lungs. Infectious work-up was positive for SARS-CoV-2 (the virus that causes COVID-19) by reverse transcriptase–polymerase chain reaction and negative for all other infections. The figure shows three images from the peripheral blood.