August, 2009

Case 257
A 43-year-old man from Brazil traveled to Angola and other African countries for business for two weeks.  Approximately one week after returning to Brazil, he noticed a small ulcerative lesion on his neck.  He recalled being bitten by insects at the site of the lesion, but could not remember if the bites took place in Africa or South America.  Two months later, he began to experience fever, headache, and fatigue and sought medical attention.  His doctor also noticed that he had swollen lymph nodes.  Blood was collected in EDTA for routine work-up.  Figures A and B show what was observed at 1000x magnification on a Giemsa-stained smear made from the EDTA blood.  What is your diagnosis?  Based on what criteria?

A	B

Click here for the answer to Case 257.

Case 258
A biopsy was performed on a 23-year-old woman with no known travel history, presenting with a perianal ulcer.  The specimen was preserved in formalin and sent to a pathology lab for work-up.  Figures A and B show what was observed at 500x magnification from a section of the tissue, stained with hematoxylin and eosin (H&E).  What is your diagnosis?  Based on what criteria?

A	B

Click here for the answer to Case 258.

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.