July, 2002

Case 87
An 11-year-old boy with HIV was seen by a physician for gastrointestinal symptoms and failure to thrive.  A duodenal aspirate was obtained and stained with modified acid-fast stain and heated safranin stain.  The safranin stain was negative and the objects shown below were found in the modified acid-fast stained smears (Figures A and B).  A wet mount evaluation using epifluorescence was also performed and the laboratory reported unspecific fluorescence.  The laboratory submitted the modified acid-fast stained slides to CDC for diagnostic assistance.  What is your diagnosis?  Based on what criteria?

A	B

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Case 88
A 27-year-old man with Hodgkin’s disease was admitted to a hospital due to cough and fever of 5 days duration.  Approximately one month later the patient had a generalized seizure with loss of consciousness for about 15 minutes.  He was alert upon admission to a hospital several hours later.  However, his left arm and leg were weak and he had intermittent twitching of both sides of his face.  Two days later he became unresponsive and his temperature ranged from 38.9°C to 40.0°C.  His breathing became irregular and a tracheotomy was performed.  Blood and urine cultures were negative for microorganisms.  Five days after admission to the hospital, the patient had another generalized seizure and died several hours later.  At autopsy, multiple soft hemorrhagic areas were noted in frontal, temporal, and parietal lobes.  The image shows what was observed on a section of necrotic brain tissue underlying the cortex of the meninges.  Objects seen in the sections ranged in size from 25 to 35 micrometers.  What is your diagnosis?  Based on what criteria?

A

Click here for the answer to Case 88.

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.