January, 2003

Case 99:
A 61-year-old woman from Rhode Island with non-Hodgkin's lymphoma had bone marrow transplants in 1996 and June 2002.  She received a single donor lymphocyte transfusion on October 1, 2002, followed by platelets and red blood cells from approximately 24 donors.  She was hospitalized several times in November and December.  She reported no recent travel outside the state of Rhode Island.  Below are images from her Giemsa stained blood smears.  What is your diagnosis?  Based on what criteria?

A	B

Click here for the answer to Case 99.

Case 100:
A 35-year-old woman, who wears contact lenses, was seen by a physician for conjunctivitis she had experienced for one year.  She had been camping in the high Sierras and Yosemite Park area about six weeks prior to being seen by her doctor.  A worm, approximately 12 to 14 mm in length, was found under the patient’s contact lens.  The doctor removed the worm and sent it to a reference laboratory for identification.  The specimen was forwarded to CDC for confirmatory identification.  A more detailed microscopic examination revealed the presence of several structures shown in the images below (Figures A, B, and C).  Figures A and B show details of the worm’s morphology, including the buccal capsule, esophagus, and striations, as indicated on the images.  Figure C shows thin-shelled eggs seen in the worm; the eggs measured approximately 47 µm by 30 µm.  What is your diagnosis?  Based on what criteria?

A	B

C

Click here for the answer to Case 100.

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.