Monday, May 11, 2015

Case of the Week 349

This week's case is a bit different in that I don't have an exact diagnosis for you. However, I have a general diagnosis and would actually like to get your opinion, dear readers, on what you think these structures are. The case was generously donated by Microbe Man. The photographs are H&E stained sections of appendix from child with acute appendicitis. The 4 objects measure 39, 46, 57 and 76 micrometers in greatest dimension and seem to be encased in a refractile shell.

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I will share with you next week how we signed this case out.

5 comments:

Anonymous said...

The bigger ones look like Hymenolepis diminuta eggs, but without hooklets...
A really weird case.

-HLCM fan

Arthur Morris said...

Tricky one. It's very hard to be sure so this is going to be a bit of a guess based on morphology and clinical history. The eggs are morphologically consistent with Schistosoma japonicum, without a travel history this would be a difficult diagnosis to make since it could be easily dismissed by lack of travel to an endemic area. The size differences are likely due to cross sections taken at different 'depths' on the ova. In all honesty it could be many things or nothing parasitic however!

Anonymous said...

I'd call incidental unknown foreign material. I doubt it's a parasite and even more that it's a human parasite; it's probably some vegetable and so on.

Anonymous said...

I agree that this is likely not a parasite. Perhaps a seed or plant material?

Anonymous said...

Hi Dr. Pritt,

What an interesting case. Could this represent adiaspiromycosis?

Here are some random sites with images (you may have to scroll to find them):

http://www.enzyklopaedie-dermatologie.de/artikel?id=14127

http://synapse.koreamed.org/DOIx.php?id=10.5625/lar.2012.28.1.67&vmode=PUBREADER#!po=90.0000

http://www.askjpc.org/wsco/wsc_showconference.php?id=93

http://people.upei.ca/pmnews/html/dec_13.html


There have been two reports of appendiceal involvement in humans after oral ingestion:

Anstead GM, Sutton DA, Graybill JR. Adiaspiromycosis causing respiratory failure and a review of human infections due to Emmonsia and Chrysosporium spp. J Clin Microbiol 2012;50(4):1346-54.

If it turns out to be appendiceal adiaspiromycosis, this should be added to the literature!

-Derrick