September, 2004

Case 139:
A 20-year-old man was sitting at his desk when he sneezed and noticed a small object fall from his nose onto his desk.  He claimed the object was moving on the desk.  He took the object to his health care provider, who thought that it was some type of worm.  The object was 0.7 cm by 0.2 cm, somewhat flat, and whitish in color.  It was sent to the pathology department where it was sectioned and stained with hematoxylin and eosin (H & E).  The pathologist captured several digital images and submitted them to CDC's DPDx for diagnostic assistance.  The object is shown in Figure A (200×) and Figures B and C (400×).  A few round objects, such as the one in Figure D (600×), were also noted; they measured about 30 micrometers in diameter.  What is your diagnosis?  Based on what criteria?  What kind of follow-up testing, if any, would you recommend and why?

A	B

C	D

Acknowledgement: This case kindly provided by Dr. Brian Staley of Ameripath.

Click here for the answer to Case 139.

Case 140:
A 41-year-old female saw her doctor because she was experiencing diarrhea, abdominal pain, and fatigue.  Her physician ordered an ova and parasites (O & P) examination.  A stool specimen was collected and sent to the AZ State Public Health Laboratory where an FEA (formalin-ethyl acetate) concentration was performed and a modified Kinyoun's acid-fast stained smear made and examined.  The laboratorian made a diagnosis and used a digital camera to capture images to send to CDC's DPDx for confirmation.  Objects seen at 1000× magnification were 8-9 micrometers in diameter (shown in Figures A-C).  Figure D shows what was observed using UV microscopy at 200× magnification; the object in D measured around 9 micrometers.  What is your diagnosis?  Based on what criteria?

A	B

C	D

Acknowledgement: This case kindly provided by the Arizona State Public Health Laboratory.

Click here for the answer to Case 140.

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.