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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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.
ReplyDeleteI 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?
ReplyDeleteGreat question. The presence of larvae and eggs, as well as the adult, allows us to rule out Trichinella.
DeleteI 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)..
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