Questions:
1. What is the diagnosis?
2. What forms of the parasite are shown in these images
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
?
Questions:
1. What is the diagnosis?
2. What forms of the parasite are shown in these images
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5 comments:
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
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.
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.
Hi Lee
That's great news! Thank you for the update, my fingers remain crossed for his full recovery.
Arthur
That's great to hear Lee. Thank you for letting us know.
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