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. 2026 Jul 13;17:1880997. doi: 10.3389/fphar.2026.1880997

FIGURE 9.

Four microscopic images show mononuclear cells with granular, purple-stained cytoplasm and irregular nuclei, each annotated with a 15 micrometer scale bar. Below, a table summarizes cerebrospinal fluid analysis: colorless, clear appearance, cell count of nine cells per microliter, zero percent polymorphonuclear cells, one hundred percent mononuclear cells, total protein of 0.001 grams per liter. Differential cytology identifies one hundred percent activated monocytes. Interpretation states mononuclear predominance with activated monocytes.

Cytological analysis of cerebrospinal fluid demonstrating infiltration of activated, lipid-laden monocytes/macrophages in Twin B. Cytospin preparation of cerebrospinal fluid (CSF) from Twin B showing abundant activated monocytes/macrophages with vacuolated cytoplasm consistent with lipid-laden macrophage morphology. These findings indicate mononuclear predominance with infiltration by activated, lipid-laden macrophages, representing central nervous system involvement secondary to macrophage activation syndrome (MAS) and correlating with the patient’s progressive neurological deterioration and refractory seizures.