Monday, May 2, 2011

Case of the Week 159

A renal allograft recipient presents with increased serum creatinine and shortness of breath. The following objects measuring 2-3 microns in length were seen in the urine on Ryan's Trichrome Blue stain: (CLICK ON IMAGES TO ENLARGE)







Identification? Could this finding be related to her respiratory symptoms?

5 comments:

Anonymous said...

The objects look like the head of spermatazoa, although the dimensions given are a bit too small...but the squamous cell present in the image suggests that there is vaginal contamination with the urine.
Going with the above, no, the finding is not related to her respiratory symptoms. B in Vt

Anonymous said...

Microsporidiosis (and yes)???

The structures remind of microsporidia. And because (a) trichrome staining of urine isn't typical, and (b) it's posted by a parisitologist, I'm guessing protist . . .

Anonymous said...

microsporidiosis; yes

Anonymous said...

Encephalitozoon, probably. Though it's another perfectly good parasite the darn mycologists stole.

Luke Roberts said...

The use of the Ryan's blue modified Trichrome stain is usually specifically for detection of microsporidia spores. I think this is what this is. Given the increased serum creatinine levels the patient evidently has renal dysfunction - the respiratory sympmtoms could be caused by the fungal microsporidia infecting mulitple organs - respiratory system has been involved in other cases but less frequently compared to small intestine, urinary tract and biliary tree, and most commonly seen in AIDS patients. The first documented case of an extra intestinal case of microsporidiosis in a renal transmplant patient was reported by Latib et al (2001) and can be found here.

http://www.ncbi.nlm.nih.gov/pubmed/11512063