Tuesday, June 1, 2021

Case of the Week 641

This week's case was generously donated by Dr. Alexander Fenwick and includes some beautiful images. 

The following objects were seen in a sputum specimen from a patient living in Eastern Kentucky. This patient was receiving corticosteroid therapy for poorly-controlled COPD. Identification?

Gram stain (10x and 100x magnification)


Wet mount:




12 comments:

CA guessing said...

Strongyloides larvae from hyperinfection but seem a little short maybe so modest confidence on this site but in real life common things being common would be confident.

Luis said...

Strongyloides larva

Anonymous said...

Nematodes larvae in the sputum bring to my mind two likely candidates, Strongyloides stercoralis and hookworm larvae. From the pictures, the larvae’s body appears fairly large but not elongated, the buccal cavity rather short, the last picture shows a genital primordium. The tails ends appear pointed. All clues converge on a diagnosis of Strongyloides stercoralis infection exacerbated by the steroid treatment.
Florida Fan

Sam said...

Strongyloides stercoralis filariform larvae. Likely from hyperinfection syndrome, as this matches with the details of the patient being on corticosteroids. Not sure what each graduation of the eyepiece graticule is equal to, so would be unable to give a measurement based on these images.

kumar sudesh said...

Strogyloides stercorallis

Anonymous said...

On closeup examination, the third picture shows a notched tail diagnostic for the filariform stage of Strongyloides stercoralis larvae.
Florida Fan

Sir Galahad said...

Larva di Strongyloides stercoralis.

Bernardino Rocha said...

Strongyloides larvae, appears to be filariform larvae. This pulmonary infection may occur during larval migration.

Unknown said...

Strongyloides larvae,usually exacerbated by steroids treatment.

Idzi P. said...

Indeed, I think I see a notched tail in the two last pictures.
This is never seen in e.g. hookworm larvae, so confirmatory for Strongyloides stercoralis filariform larvae.
Strongyloides and corticosteroids...always tricky!

Anonymous said...

I’ve just received word that I have this. I’ve never traveled to Thailand or other area it’s found in. They found it while screening for kidney donation. Anyone experienced this?

Tegegn said...

Strongyloides stercoralis autoinfective larvae from desiminated Strongylodiasis from in immunocompromised patient with corticosteroid drug.