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Case #289 - December, 2010

A 47-year-old woman originally from El Salvador had been living in Minnesota for 16 years. She visited family in El Salvador for about a month during the summer. One month after returning to Minnesota, she was admitted to a local hospital for an appendectomy. Biopsy specimens were collected and sent to a pathology lab for routine sectioning and staining. The surgical pathology showed a granulomatous appendicitis with abundant eosinophils with what appeared to be an intravascular helminths. Her absolute eosinophil count was 500. Images (Figures A-D) were captured and sent via email to DPDx for diagnostic assistance. The images in Figures A and C were captured at 100x magnification; the images in Figures B and D at 160x magnification. What is your diagnosis? Based on what criteria?

Case289_A

Figure A

Case289_B

Figure B

Case289_C

Figure C

Case289_D

Figure D

Case Answer

This was a case of angiostrongyliasis caused by Angiostrongylus costaricensis. Diagnostic morphologic features included:

  • a thin cuticle and small lateral chords (LC, Figure D).
  • coelomyarian/polymyarian muscle cell type.
  • coiled reproductive tubes (RT, Figure D).
  • eggs in utero (E, Figure B).
  • a thick-walled, multi-nucleate intestine (IN, Figures B and D).
  • location in the patient (appendix), which helped rule-out Angiostrongylus cantonensis.

Figure B


Figure D

More on: Angiostrongyliasis

This case and images were courtesy of Regions Hospital, St Paul Minnesota.

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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DPDx is an education resource designed for health professionals and laboratory scientists. For an overview including prevention and control visit www.cdc.gov/parasites/.

  • Page last reviewed: August 24, 2016
  • Page last updated: August 24, 2016
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