Wednesday, June 19, 2024

Case of the Week 750

This week's case is an interesting challenge! It was donated by Drs. David Sullivan and Ted Nash. The patient is a young girl from Ethiopia with intermittent GI distress. Her parents said that she had passed several ovoid objects per rectum. One of these objects was submitted for histologic sectioning and revealed the following.

A stool parasite exam also revealed the following. 

Based on these findings, what is your diagnosis?


Anonymous said...

Plant material?

Florida Fan said...

Wow, this week Dr. Pritt takes us on a wild ride. First, the HE stained objects did not remind me of any parasite but maybe some seeds or pods consumed by the patient. The Iodine stained object resembles an egg of Bertiella species. Since the patient is from Africa, I suspect this is a case of Bertiella studeri. The girl could have consumed some fruit contaminated by monkeys.
Florida Fan

Anonymous said...

Based on the description of the patient—a young girl from Ethiopia with intermittent gastrointestinal distress—and the information that she passed several ovoid objects per rectum, it suggests a parasitic infection. Given the additional detail that one of these ovoid objects was submitted for histologic sectioning, we can narrow down the possible diagnoses to a parasitic organism known to produce ovoid structures.

In tropical and subtropical regions such as Ethiopia, parasitic infections are common, and the description of ovoid objects being passed per rectum is indicative of a helminth infection. The key parasites that fit this description are typically related to intestinal worms. One specific parasite that matches this description closely is Hymenolepis nana, commonly known as the dwarf tapeworm.


Hymenolepis nana (Dwarf Tapeworm) Infection


• Clinical Presentation: The patient, a young girl from Ethiopia, has intermittent gastrointestinal distress, which is consistent with symptoms caused by Hymenolepis nana.
• Ovoid Objects: The ovoid objects passed per rectum are likely proglottids (segments) of the dwarf tapeworm or eggs.
• Histologic Sectioning: Histologic examination of the ovoid object would reveal characteristic features of Hymenolepis nana, such as the presence of hooklets and filaments.

Supporting Details:

• Geographic Prevalence: Hymenolepis nana is more common in areas with poor sanitation and in children, particularly in developing countries.
• Life Cycle: The eggs of Hymenolepis nana can be directly infectious and are passed in the feces, explaining the passage of ovoid objects.
• Symptoms: Symptoms can include abdominal pain, diarrhea, and other gastrointestinal disturbances, aligning with the girl’s presentation of intermittent GI distress.

Further Steps:

• Microscopic Examination: Confirmatory diagnosis would involve microscopic examination of stool samples to identify the characteristic eggs of Hymenolepis nana.
• Treatment: Treatment typically involves antiparasitic medications such as praziquantel or niclosamide.

In conclusion, based on the information provided, the diagnosis is most likely an infection with Hymenolepis nana. Further diagnostic tests, including stool examination, would confirm this diagnosis.

Idzi P. said...

Waauw! Interesting case with beautiful pictures!
At first I thought this would be plant material, but the egg is quite typical for Bertiella sp. showing the typical pyriform apparatus inside.
Secondly, in the third histology picture I think I see calcareous corpuscles, typical for and consistent with a cestode structure, together with an eosinophilic a-cellular tegument.
So I'll follow Florida Fan with the diagnosis of Bertiella sp. infection.

Florida Fan said...

To Idzi: Your comment make sense. This is a bug we rarely see and on top of that reading Pathology HE smear is “where I suck “.
Florida Fan

Anonymous said...

I don't think it's Hymenolepis. I didn't know what it was. Never heard of Bertiella. Had to look it up! Cool. Learn something new every day!

Mourad said...

The axis of the body which is made of segments (metameres) reminds me of polychaete worms or their larvae.
for the second image it is undoubtedly a globose chlamydospore of a fungus of the genus Glomus sp.

Idzi P. said...

On second thought: could still be plant material…
I’m lost here…
Please help us out of our suffering Dr. Pritt!

Anonymous said...

The first HE stained samle looks as artifical fragment , may it is plant seeds, but the oval shape iodine stained photo looks as Hymenolips nana ova