This week's case was generously donated by Dr. Adrienne Showler. The patient is an immunocompromised middle-aged man from El Salvador who presented with vomiting, diarrhea, and weight loss. The following are hematoxylin and eosin-stained images of the duodenal biopsy. What is your diagnosis? What are the structures shown?
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4 comments:
The fact that this patient is immunocompromised leads me to a diagnosis of Strongyloides stercoralis infection. Since interpreting HE smear has never been my cup of coffee, I would depend on a PCR for confirmation and anxiously awaiting the how and why from Dr. Pritt.
I think it's a female of Strongyloides stercoralis, but, how do we know it's not females of Trichinella spiralis aside from the symptoms of the patient?
I like for stongyloides on a pattern pathology basis of sections having seen a couple of cases - that's the Aunt Mary rule of you recognize Aunt Mary but may not be able to explain, may be able to teach and AI will figure out. Pathology H&E sections are a total artifact with very little connection or basis in biology or measurement so is pretty basically an empirical system. If a pathologist needs to go past 10x there is little hope of learning anything while I admire those who know how to use oil and 50x or 100x. As a corollary never ever let a pathologist look at a Gram stain (unless her name is Pritt)..
Great question. The presence of larvae and eggs, as well as the adult, allows us to rule out Trichinella.
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