A seven-year-old, previously healthy child developed flu-like symptoms
and rapidly progressive bulbar palsy, coma, and eventually death.
Imaging revealed florid ventriculitis. A viral etiology was
initially suspected. The autopsy revealed extensive necrotizing
(mixed inflammatory, occasional giant cells, vasculitic) granulomatous
encephalitis (Figures A and B), with a subependymal
necroinflammatory process. Tissue sections of the brain were made
and stained with hematoxylin and eosin (H&E). Images of the brain
and subsequent tissue sections (Figures C and D, taken at
1000x oil magnification) were sent to DPDx for diagnostic assistance.
What is your diagnosis? Based on what criteria? What further
testing is recommended?
Acknowledgement: The case
and the images were kindly contributed by Dr. Carlos Galliani and the
Cook Children’s Hospital in Fort Worth, TX.
here for the answer to Case 223.
A 47-year-old male with travel history
to the Galapagos Islands, Ecuador and Colombia presented to his health
care provider with follicular conjunctivitis. A worm-like object
measuring approximately 3.0 mm was removed from his eye and sent to a pathology laboratory for
analysis. The object was sectioned, stained with hematoxylin and eosin
(H&E) and examined microscopically. Figure A shows the object at 40x
magnification; Figure B shows a close-up of one end of the object at
100x magnification. What is your diagnosis? Based on what criteria?
here for the answer to Case 224.
presented in the monthly case studies are from specimens submitted for diagnosis or
archiving. On rare occasions, clinical histories given may be partly