August, 2000

Case 41
A 9-year-old boy was taken to his pediatrician for sudden headaches, fatigue, and loss of muscle coordination.  His family lives on a ranch located approximately 80 miles northeast of San Francisco, CA.  Clinical laboratory tests indicated eosinophilia and eosinophilic meningoencephalitis.  Repeated stool tests were all negative for parasites.  Significant in the history provided by the family was the fact that a family of raccoons had taken up residence in a storage shed in the same area of the yard where the child often plays.  A brain biopsy was ordered and nematode larvae were found.  Figure A shows what the pathologist found in an H & E (hemotoxylin and eosin) stained section obtained from a brain biopsy.  An epidemiological investigation was initiated as a result of the nematode found in the biopsy.   As part of this investigation, a pooled sample of raccoon feces was collected and examined for intestinal parasites.  Numerous eggs similar to the one shown in the Figure B were seen.  What is your diagnosis?  Based on what criteria? 

A	B

Click here for the answer to Case 41.

Case 42
A reference laboratory received one trichrome stained slide from a local health care facility requesting an O & P (ova and parasites) examination on a 25-year-old man whose symptoms included abdominal cramping and intermittent diarrhea.  The images below show the objects seen on the submitted slide.  The objects averaged 4.5 to 5.5 micrometers in diameter.  What is your diagnosis?  Based on what criteria?  What else would you recommend?

A	B

Click here for the answer to Case 42.

Images presented in the monthly case studies are from specimens submitted for diagnosis or archiving.  On rare occasions, clinical histories given may be partly fictitious.