March, 2007

Case 199:
A huntsman killed a bear and prepared it for eating and freezing by cutting it into roasts, steaks, and grinding the trimmings.  Later that same day, he ate a burger made from some of the fresh meat and cooked rare.  Approximately two and a half to three weeks later, the hunter experienced fever, diarrhea, and muscle pain.  However, medical attention was not sought for another six weeks.  He had elevated eosinophilia and several laboratory tests were ordered.  The Division of Parasitic Diseases' reference diagnostic laboratory received some of the bear meat for examination.  A digestion technique using 0.1% pepsin and 0.1% hydrochloric acid was used on the meat and a muscle squash was made from the softened tissue.  Figure A, taken at 400× magnification, and Figures B-E, taken at 1000× magnification, show what was observed.  What is your identification of the objects in the meat?   What is your diagnosis?  Based on what criteria?

A	B

C	D

E

Click here for the answer to Case 199.

Case 200:
Approximately one and a half months after a trip to Costa Rica, a man developed a papule on the back of his right hand.  The papule progressed to a 2 cm ulcer with a raised border.  The ulcer was not tender but was draining serous fluid, and the surrounding skin was red and swollen.  A second, similar eruption occurred on the same hand, and the man sought medical attention.  His physician gathered clinical and travel history, examined the lesions, and contacted the Division of Parasitic Diseases for assistance.  Tissue scrapings and a punch biopsy were collected.  Suspicious objects were reported by the pathologists who reviewed the slides.  Specimens were sent to DPD’s reference diagnostic laboratory for review.  Figures A-C, taken at 1000× magnification, show what was seen on a Giemsa stained smear of a tissue scraping.  What is your diagnosis?  Based on what criteria?  What other testing, if any, is indicated?

A	B

C

Click here for the answer to Case 200.

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.