Thursday, August 17, 2017

Case of the Week 456

This week's case was generously donated by Idzi Potters from the Institute of Tropical Medicine in Antwerp. The following were seen in a liquid culture of a skin biopsy using Tobie Sang Lapin (TSL) medium (Phase contrast, x1000 magnification). The specimen was first ground in a dounce tissue grinder. Diagnosis?

What are these structures?

Check out their classic motility here:

Monday, August 7, 2017

Case of the Week 455

This week's impressive case was donated by Dr. Peter Gilligan and Dr. John Hunt. The patient is a middle-aged man from Nigeria who presented with signs of increased intracranial pressure including nausea and vomiting. An MRI showed dilated ventricles and irregular lesions in the cerebellum. Below is the material that was resected:

The following are H&E-stained images of this material. Identification?

Sunday, August 6, 2017

Answer to Case 455

Answer: Coenurosis, an infection with the larval form of either Taenia serialis or T. multiceps. While the the former has a predilection for soft tissue, the latter commonly involved the eye and central nervous system and is the likely 'culprit' in this case. The multicystic nature and presence of multiple protoscoleces within a cyst is characteristic for coenurosis and allows this infection to be differentiated from cysticercosis which only has one protoscolex per cyst.
Also note that the protoscoleces are larger and more complex than those of Echinococcus species, allowing us to rule out this similar cestode infection.
The CDC DPDx group has some great information and photographs of coenurosis which you can find here:

Thank you to everyone who wrote in on this challenging case, and kudos to Blaine for getting it correct!