Table 1.

Ancillary tests performed during investigation of this case are summarized.

Test	Tissue	Result
KOH (potassium hydroxide) wet mount	Lung impression smears	Negative for fungal spherules suggestive of Coccidioides sp
Cytology (Diff-Quik)	Rib osteolytic lesions impression smears	Negative for infectious agents, neoplastic or inflammatory cells
Fungal and aerobic bacterial cultures	Lung and hilar lymph nodes tissues	Negative growth
Hematoxylin and eosin, Gram, Periodic acid–Schiff (PAS), and acid fast stains	Lung and hilar lymph nodes histological sections	Negative for infectious organisms
Serum electrophoresis	Frozen serum	Normal
Transmission electron microscopy (TEM)	Osteolytic lesion – rib, vertebra, and stylohyoid bones	Putative etiological agent(s) not observed