Monday, March 16, 2015

Case of the Week 341

The following images are from an autopsy of a woman with end-stage ovarian cancer who developed respiratory failure and sepsis.  The tissue type is small intestine. This is an old case from the Armed Forces Institute of Pathology (AFIP) that I found in my files over the weekend.  It is such a shame that they closed - they were such a wonderful resource.

Questions:
1. What is the diagnosis?
2. What forms of the parasite are shown in these images

 







?


5 comments:

Anonymous said...

This case exemplifies the typical Achille's tendon of a tech: tissue sections stained with HE.
Never the less, my guest is rhabditiform larvae of Strongyloides stercoralis burrowing back into the intestinal villi for an autoinfection.
The pulmonary involvement and the size of the larvae are compatible to this etiology.

Florida Fan

Arthur Morris said...

Looks to me like Strongyloides stercoralis. I would guess that it was benign until immunosuppressive chemotherapy began to treat the cancer, at which point a hyperinfective syndrome developed due to the opportunistic and autoinfective nature of this worm. The respiratory failure is likely due to the damage the worms do during the pulmonary stages of the life cycle, and sepsis is well documented in hyperinfective strongyloidiasis due to the filariform larvae penetrating the mucosa to reach circulatory system, dragging coliform bacteria into the blood stream.

Anonymous said...

I thought Strongyloides as well.. Lee

Update on the prior case. I spoke to one of his Oncology fellows at his current hospital. He is still in the hospital, on ivermectin, back on chemo and no longer septic...YEAH!! Good news.

Arthur Morris said...

Hi Lee

That's great news! Thank you for the update, my fingers remain crossed for his full recovery.

Arthur

Bobbi Pritt said...

That's great to hear Lee. Thank you for letting us know.