Sunday, June 7, 2015

Case of the Week 352

The following structures were seen in a hematoxylin and eosin-stained perianal skin biopsy from an Ethiopian man with recurrent colorectal fistulae and abscesses.  Presumptive identification? What study would you recommend to confirm your diagnosis?

100x total magnification


200x total magnification

 400x total magnification

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8 comments:

  1. AnonymousJune 7, 2015 at 6:46 PM

    The objects are morphologically suggestive of nematodes cross sections, possibly hook worm or Strongyloides stercoralis in an auto infection. O&P examinations of fecal material are suggested.

    Florida Fan

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  2. RastaBobJune 8, 2015 at 5:53 AM

    Schistosoma mansoni egg?

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  3. AnonymousJune 8, 2015 at 1:09 PM

    I was thinking Schistosoma ova as well. Lee

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  4. AnonymousJune 8, 2015 at 6:28 PM

    Looks great for Schistosomiasis!- Jen

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  5. Rashna MeunierJune 8, 2015 at 7:46 PM

    My vote is for Schistosoma mansoni.

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  6. AnonymousJune 11, 2015 at 8:52 PM

    Last two images have the lateral spine visible

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  7. AnonymousJune 12, 2015 at 3:08 PM

    I like for S mansoni too. Probably would do both stool O&P x several and serology depending on treatment history. [Most efficient testing I suspect is actually to ask a Pritt or similar actually and just treat.]

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  8. UnknownJune 15, 2015 at 9:56 AM

    S.mansoni ova is the only thing that I feel it is reasonably likely to be. Bodies residing within granulomatous tissue, with a lateral spine (presumably) present on image 4; morphology is vaguely consistent but not definitive. Epidemiology is consistent as is presentation. Quite a tricky one to sign off.

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