Killers on the road: Klebsiella and Pseudomonas bacteremia detected on peripheral blood smear.

A 78-year-old woman hospitalized for investigation of ascites presented with weakness, loss of appetite, fever, and chills. A complete blood count showed anemia, leukocytosis, and thrombocytopenia (hemoglobin, 8.5 g/dL; leukocytes, 27.5 3 10/L; platelets, 50 3 10/L). Peripheral blood smear demonstrated the presence of neutrophilia with left shift (promyelocytes, 0.3 3 10/L; myelocytes, 1.9 3 10/L; metamyelocytes, 2.2 3 10/L; band neutrophils, 2.2 3 10/L; and segmented neutrophils, 19.7 3 10/L) and distorted granulocytes containing toxic vacuoles and intracellular structures that exhibit a uniform and definite rod shape (arrows), suggestive of phagocytized bacilli (panels A-B). Blood cultures confirmed the blood smear findings and revealed the presence of 2 species of bacillus, Klebsiella pneumoniae and Pseudomonas aeruginosa.