Friday, January 22, 2016

Case of the Week 382

The following are photos of kidney biopsies from a Mexican man with HIV. Diagnosis?

Hematoxylin and eosin (H&E), 40x
 
H&E, 200x
H&E, 1000x
Jones Silver stain, 1000x (inset approximately 2000x)


11 comments:

Anonymous said...

Leishmaniasis

Anonymous said...

The morphology of the organism is compatible with amastigotes of Leishmania sp. The organisms did not pick up silver stain indicates they are not fungal in origin. The patient has HIV and this predisposes the patient to Leishmania infection.

Florida Fan

Justine said...

Leishmania is my first option too, but I would like to know how would you rule out Trypanosoma cruzi. Is it possible just on morphology? We had a recent case in the brain and the microbiologist diagnosed leishmania too with the citology material. It was Chagas.

Arthur Morris said...

My differential was microsporidia or Leishmania, however going on morphology alone my answer is a Leishmania infection due to the presence of a rod shaped Kinetoplast along side the nucleus in the amastigotes. The size (1um) is also consistent with this diagnosis.

Anonymous said...

Leishmaniasis, given the presence of the rod shaped kinetoplasts presen and the cell type infected. In order to distinguish Trypanosoma spp. from Leishmania, I was taught to look at the cell type in which the organisms are found. Leishmania is present in macrophages while Trypanosoma is present in somatic cells (cardiac tissue, for example). In this case, it looks like there are lymphoid aggregates present in the area of the organisms, likely supporting that they are contained within macrophages.

Anonymous said...

Visceral Leishmaniasis

Justine said...

That's interesting, thank you. Nonetheless, in the case I mentioned, they were seen both inside and outside macrophages. I admit it was a huge brain abscess in an Aids patient and probably in this scenario they would get into anything.

mona said...

visceral leishmania

Johari Surin said...

Intracellular nature of the organism, with a "dot" ie the nucleus and a "dash" ie. the axoneme kinetoplast. Leishmania sp.

Johari Surin said...

LD bodies of Leishmania

Carlos said...

My diagnosis is Chagas. The clinical history is important here (there also may be the size of amastigotes to differentiate Leishmania versus T.cruzi, and we should review that). But, visceral leishmaniasis or a visceralized tegumental leishmaniasis in a HIV patient, the strinking feature is bone marrow insufficiency and its three main findings: anemia, leucopenia and plaquetopenia. No one would go to kidney biopsy with plaquetopenia.