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Monthy Case Studies - 2002
Case #90 - August, 2002
A 50-year-old man was admitted to the hospital three times between January and June 2001 for intractable abdominal pain and intermittent fever. The man emigrated from China several years ago. Tests revealed a liver abscess in the posterior part of the right lobe, which was aspirated. A diagnosis was not made at that time. The abscess was still present in May 2001 and the man was admitted to the hospital for a liver biopsy. Below are images from the biopsy. The egg marked in Figure C measured 55 µm by 35 µm. What is your diagnosis? Based on what criteria?
Figure A
Figure B
Figure C
Acknowledgement: This case was kindly provided by the Michigan Department of Community Health.
Answer to Case #90
This was a case of ascariasis caused by Ascaris lumbricoides. The images showed the remnants of eggs in the tissue. In this particular case, a gravid female worm had migrated to the liver and died where the abscess and subsequent biopsy were taken. The worm was absorbed by the host, but eggs remained long after the worm itself was gone. This also explains the presence of a large mass of eggs, which would have been contained within the uteri, rather than smaller numbers of eggs dispersed throughout the tissue. Initial consideration focused on one of the trematodes typically inhabiting the liver, such as Clonorchis or Fasciola. However, size and morphology of the eggs excluded these from consideration.
More on: Ascariasis
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.
