January, 2007

Case 195:
A patient complaining of intermittent symptoms including coughing up blood, fever, and other vague "flu-like" symptoms saw a physician.  The patient reported working at a sushi restaurant and eating a raw crab on a dare (Figure A shows a crab similar to the one that the patient ate).  Blood tests were ordered and results included peripheral eosinophilia of 10% and a history of bilateral pneumothorax (free air or gas in the pleural cavity).  A biopsy yielded a cyst containing a structure 5 mm in length and 2 mm in width.  Figure B (40×) and Figure C (100×) show a hematoxylin and eosin (H & E) stained section of the specimen.  Figure D (400×) shows an object which measured 80-90 µm by 40-45 µm.  Similar objects were found in low numbers in sections of lung tissue.  What is your diagnosis?  Based on what criteria?

A	B

C	D

Click here for the answer to Case 195.

Case 196:
A missionary traveled to various countries in sub-Saharan Africa for one year.  He went to his physician complaining of abdominal pain and occasional diarrhea which he experienced since his return to the U.S.  He reported he swam in various lakes while he was abroad.  An ova and parasite (O & P) stool examination revealed objects, measuring 135 µm, like the one shown in Figures A and B (200×).  The images show the same area of the slide but two separate focal planes.  What is your diagnosis?  Based on what criteria?

A	B

Click here for the answer to Case 196.

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.