A 62-year-old female with a history of sarcoidosis and hypertension presents to the ED for 4 days of fever, vomiting, malaise and generalized abdominal pain that is worst in the right upper quadrant.  Her vitals are normal except for a temperature of 102.1 F.  Her exam is otherwise normal except for generalized abdominal tenderness with guarding in the right upper quadrant, an enlarged spleen and a few petechiae on both shins.

An abdominal ultrasound shows a dilated gallbladder with a thickened wall and pericholecystic fluid, but no stones or sludge.  The spleen is also noted to be enlarged.  Her lab tests are notable for a sodium of 127, an AST of 441, an ALT of 288 and a platelet count of 14,000.  A blood smear is done due to the low platelets.

What diagnostic finding is shown in the smear below? What is the diagnosis? What is the treatment?

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