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Monthy Case Studies - 2000
Case #27 - January, 2000
A 50-year-old historian from Boston lived in several coastal villages in Japan for six months. His diet consisted mainly of seafood, including sushi and crab. He ran out of his usual pipe tobacco after two months and began smoking local varieties. After three to four months in Japan, he occasionally noticed small brownish specks in his sputum. After returning to Boston, he had a physical examination at a local hospital that included a stool examination. The following images were captured from a wet preparation of a formalin-ethyl acetate concentration of his stool specimen (Figures A and B, 200×). The size of both objects was approximately 93 micrometers by 49 micrometers. What is your diagnosis? Based on what criteria?
Figure A
Figure B
Answer to Case #27
This was a case of paragonimiasis caused by Paragonimus westermani. Diagnostic features observed were:
- the size of these eggs is within the range for P. westermani eggs.
- the presence of an operculum (blue arrows, both figures).
- a thickening of the abopercular end of the shell (green arrows, both figures).
The small, brown specks in the patient's sputum were clusters of eggs. The adult P. westermani lives in the lungs. The eggs are often passed in the stool or coughed up and either spit out or swallowed.
Figure A
Figure B
More on: Paragonimiasis
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.
