The patient is a 40 year old male who presented to the emergency department with flu like symptoms and was subsequently admitted to the Intensive care unit for acute respiratory distress syndrome. Laboratory investigation revealed that the patient was HIV positive with a CD4 count of 50/uL. Shown below is a peripheral blood smear which shows neutrophils filled with multiple intracellular yeast. He is clinically suspected to have disseminated histoplasmosis although fungal cultures are pending.