Monday, March 30, 2015

Case of the Week 343

The following biopsies of small intestine are from a patient with chronic watery diarrhea.  Diagnosis? (CLICK ON IMAGES TO ENLARGE).

H&E, 200x

H&E, 400x

H&E, 1000x

I'd like to thank Dr. Duane Newton who allowed me to borrow his slides and take these photographs.
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11 comments:

  1. UnknownMarch 30, 2015 at 10:42 AM

    Criptococco

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  2. UnknownMarch 30, 2015 at 10:43 AM

    Criptococco

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  3. UnknownMarch 30, 2015 at 2:42 PM

    Microsporidiosis

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  4. AnonymousMarch 30, 2015 at 9:42 PM

    I have no experience reading HE stained sections, but it seems like the patient may be infected with giardiasis.

    Florida Fan

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  5. UnknownMarch 31, 2015 at 4:33 AM

    Looks to me like Cyclospora cyetanensis with what looks to be meronts apparent in images 3-5 and potentially some microgamonts. This would be consistent with the symptom of chronic watery diarrhoea. It is often contracted during travels to endemic areas and brought back home.

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  6. Lukus RobertsApril 1, 2015 at 7:47 AM

    I think cyclospora too. a secondary feature of villous blunting/atrophy is also apparant which, in the abscence of successful identification of parasites (i believe cyclospora can be easily missed) could lead to a false diagnosis of , for instance, coeliac disease.

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  7. JustineApril 1, 2015 at 8:21 AM

    I wouldn''t know how to tell between cyclospora and isospora. Cryptococcus is usually located just on the surface I would say. Any tips?

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  8. JustineApril 1, 2015 at 8:26 AM

    I meant to say Cryptosporidium, not cryptococcus.

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  9. AnonymousApril 1, 2015 at 2:26 PM

    I am stuck between Cyclospora (I think too big) Cryptosporidia or Isospora..

    Lee

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  10. Alan HigginsApril 1, 2015 at 8:53 PM

    Looks like Microsporidia to me. Looks too big to be Cryptosporidium or Cyclospora. Nice eosinophils! Is the patient immunocompromised?

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  11. AnonymousApril 2, 2015 at 3:50 PM

    Let's see a trichrome stain. O and p s are done with trichrome stains not HE.

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