Case of the Week 682

This week we have a special guest author, Hadel Go, a medical student (Class of 2024) who is greatly interested in parasitology. I'm very excited that Hadel will be our first ever guest author! The following is our case that she will be teaching us about later this week.

The patient is a young man from Madagascar who presented with a 1-week history of chest pain, night sweats, and fever. Chest X-ray showed a right upper lobe peripheral cavitary lesion. Work up for tuberculosis including AFB stained smears of sputum and sputum PCR using the Xpert MTB/RIF assay were negative. Therefore, a wedge resection of the abscess was performed and revealed the following (H&E stain, 400x original magnification):

What is your diagnosis?

Case of the Week 681

This week's case was generously donated by Tracie Rose from Seattle. The following objects were seen in a Papanicolaou-stained preparation of aspirate fluid from a liver cyst. the patient is from Afghanistan. 

Identification? 

Answer to Case 681

 Answer: Echinococcus sp. invaginated protoscolices

Given the clinical history of a cystic lesion in a patient from Afghanistan, the causative agent is probably E. granulosus. 

The protoscolices are somewhat degenerated, but you can still make out the internal row of hooklets:

The protoscolex will evert if ingested by the canine definitive host and form the scolex of the adult tapeworm. Thanks again to Tracie Rose and her lab for donating this case!

If you liked seeing parasites stained with the Papanicolaou (pap) stain, you can also check out this previous case of Schistosoma haematobium eggs in urine. The pap stain is really quite beautiful!

Case of the Week 680

 This week's case is from Drs. Harsha Sheorey and Lauren McShane from Australia. The following were seen in bronchial washings from an immunocompromised patient (fluorescent prep for fungi and wet preps):

Here are the culture plates from the bronchial washings.

The patient also has Gram negative bacteremia. 

Diagnosis? As a bonus, what forms are we seeing in the respiratory specimens?

Answer to Case 680

 Answer: Strongyloides stercoralis hyperinfection

This impressive case shows numerous L3 (or possibly L4) S. stercoralis larvae from bronchial washings, and the accompanying culture plates showing bacterial colonies growing in the wake of migrating larvae. 

Thanks again to Harsha and Lauren for donating this case!