August, 2002

Case 89:
A 55-year-old missionary traveled to Guatemala, the Dominican Republic, and the Ivory Coast in a three month period.  The man fell ill during a church conference after returning home from the trip.  He was taken to an emergency room with a high fever (102.5°F), chills, aches, profuse sweating, nausea, and vomiting.  He had taken malaria prophylaxis while on the Ivory Coast, but stopped taking it upon returning to the United States.  The objects in the images below were seen in his Giemsa stained blood smears (Figure A is a thick smear; Figures B and C are thin smears).  What is your diagnosis?  Based on what criteria?

A	B

C

Click here for the answer to Case 89.

Case 90:
A 50-year-old man was admitted to the hospital three times between January and June 2001 for intractable abdominal pain and intermittent fever.  The man emigrated from China several years ago.  Tests revealed a liver abscess in the posterior part of the right lobe, which was aspirated.  A diagnosis was not made at that time.  The abscess was still present in May 2001 and the man was admitted to the hospital for a liver biopsy.  Below are images from the biopsy.  The egg marked in Figure C measured 55 µm by 35 µm.  What is your diagnosis?  Based on what criteria?

A	B

C

Acknowledgement: This case was kindly provided by the Michigan Department of Community Health.

Click here for the answer to Case 90.

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.