May, 2008

Case 227
A 19-year-old male from Louisiana with no known travel history outside the United States presented to his health care provider with a one-month history of headache, fatigue, shortness of breath and weight-loss.  A chest radiograph showed significant bilateral pleural effusions with an infiltrate in the left lung.  Bronchial alveolar lavage (BAL) and sputum specimens were collected for complete microbiologic and pathologic work-up.  Figures A and B show Papanicolaou-stained concentrates from the BAL specimens.  Figure A and B were taken at 100x and 1000x oil magnification, respectively.  Objects in the figures measured approximately 85-90 micrometers long by 55-60 micrometers wide.  What is your diagnosis?  Based on what criteria?

A	B

Acknowledgement: These images were kindly contributed by Dr. Gary Procop.

Click here for the answer to Case 227.

Case 228
Within a week of returning from a conference in Mexico, a 28-year-old woman presented to her primary care physician with cramps, abdominal pain, gas and diarrhea.  A routine Ova and Parasite (O&P) examination was performed on stool specimens.  Figures A-F show objects observed on a trichrome-stained slide prepared from the stool.  All images were taken at 1000x oil magnification.  The objects in Figures A-C measured 12 micrometers.  The objects in Figures D and E averaged 10 micrometers.  The object in Figure F measured 12 micrometers in diameter.  What is your diagnosis?  Based on what criteria?

A	B

 

C	D

 

E	F

Click here for the answer to Case 228.

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.