March, 2008

Case 223
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?

A	B

C	D

Acknowledgement:  The case and the images were kindly contributed by Dr. Carlos Galliani and the Cook Children’s Hospital in Fort Worth, TX.

Click here for the answer to Case 223.

Case 224
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?

A	B

Click here for the answer to Case 224.

Images presented in the monthly case studies are from specimens submitted for diagnosis or archiving.  On rare occasions, clinical histories given may be partly fictitious.