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Monthy Case Studies - 2014

Case #372 - May, 2014

A 45-year-old patient originally from Mexico presented with a left groin lymphocele, erythema, swelling in his lower extremities, and fever and chills approximately one month after receiving a heart transplant. An endomycardial biopsy was performed and blood specimens were collected in EDTA and sent to Hematology for work-up. Objects of interest were observed by the attending pathologist on a thin blood film stained with Wright stain. Images were captured and sent to the DPDx Team for diagnostic assistance. Figures A-D show four of the images submitted. What is your diagnosis? Based on what criteria?

Figure A

Figure A

Figure B

Figure B

Figure C

Figure C

Figure D

Figure D

Acknowledgements: This case and images were kindly provided by Aurora St. Luke’s Medical Center, Milwaukee, WI.

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Answer to Case #372

This was a case of Chagas disease (American trypanosomiasis) caused by Trypanosoma cruzi. Diagnostic morphologic features included:

  • trypomastigote forms of the parasite with a large posterior kinetoplast and an undulating membrane with an anteriorly-directed flagellum (Figures A-D).
  • trypomastigotes exhibiting a C-shaped form (Figures A and D).

The patient’s origin in Latin America was also important, as the other human trypanosome species, T. brucei, is endemic to Africa.

More on: American trypanosomiasis

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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.

 
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