Sunday, April 29, 2012

Case of the Week 206

A 53 year old male presented with signs of meningitis including severe headache, nausea, vomiting, and neck stiffness.  This later progressed to seizures, neurologic abnormalities, and coma. Examination of the CSF showed elevated opening pressure, elevated protein, and eosinophilia.  The patient expired and an autopsy was performed.  The following are H&E stained sections of brain.  What is your differential diagnosis? (CLICK ON IMAGES TO ENLARGE)

(400 time original magnification)

(100 time original magnification)

 (200 time original magnification)

(400 time original magnification)


6 comments:

Matthew Rollosson said...
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Matthew Rollosson said...

Angiostrongylus cantonensis

vspyder said...

Angiostrongylus cantonensis is the most common cause of eosinophilic menhingitis in asia and the south pacific - but you havent told us the where the patient had been previous to becoming ill, i wouldnt like to say for sure that it is this. The stained sections definatly show nematodes however and I can't think of any other brain enchephalitis causing nematodes right now...

MicrobeMan said...

I'll go with Angiostrongylus cantonensis as well. Perhaps the patient does have history of travel that we just don't know about - after all, sometimes the whole picture

MicrobeMan said...

...isn't presented by those submitting specimens, etc.

Matthew Rollosson said...

A. cantonensis "has also been found in Australia, some areas of Africa, the Caribbean, Hawaii and Louisiana."
http://www.cdc.gov/parasites/angiostrongylus/epi.html