Case Number : Case 45 Posted By: Guest

Phillip McKee - Overseas consultations (USA) Wrote:

The correct diagnosis is histoplasmosis. With the eye of faith, the organisms are surrounded at least focally by a clear halo mimicking a capsule. The silver stain was positive. See you all tomorrow and thank you for all of your contributions.

Submitted on 11/08/2010 21:10
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil, Ecuador) Wrote:

Or Toxoplasma...

Submitted on 11/08/2010 20:22
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil, Ecuador) Wrote:

Sir.. if it is not Leishmania, I still think it is a protozoan. Chagas disease in immuonsuprressed host with skin involvment is a possibility (once I saw a case in a meeting )

Submitted on 11/08/2010 20:16
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Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Dear Sir, Your comment will make histoplasmosis on top of the list. The organisms are mainly inside giant cells. I think this is seen in the African type of histoplasmosis. Still penicillosis could be the differential in Hx and Eosin sections like this.

Submitted on 11/08/2010 15:29
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

I see multinucleate histiocytic cells containing small engulfed intracytoplasmic microorganisms. This could be leishmaniasis or histoplasmosis. Clinico-pathological correlation and appropriate stains should facilitate distinction between these two entities.

Submitted on 11/08/2010 15:19
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Phillip McKee - Overseas consultations (USA) Wrote:

Good morning all. I think that you should take into account the location of these organisms and the apparent lack of inflammation bewteen the giant cells. In leishmaniasis one expects to see a heavy lymphocytic and plamsa cell infiltrate. This should help focus your minds.

Submitted on 11/08/2010 14:56
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Iskander Chaudhry - (UK) Wrote:

Leishmaniasis. Beautiful case. Graham great to see you post your comments and look forward to seeing you at next year's update course. The online course is going through beta testing so we hope it will be out by the end of this month. I will keep you posted.

Submitted on 11/08/2010 11:20
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Richard Carr - Warwick (UK) Wrote:

Diagnosis: Leishmania. Agree with comment below, usually you can get the impression of the capsule in histoplasma capsulatum (not in this case). Penicillosis?? that's a new one on me - must look it up!!

Submitted on 11/08/2010 10:14
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Graham Reilly - Princess Hospital (Guernsey UK) Wrote:

Plasma cells and macrophages with granular inclusions that look like amastigotes consistent with leishmaniasis.Can`t think of a differential.Excellent website.Is there a date for your online course starting?

Submitted on 11/08/2010 09:23
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Leishmaniasis. DD Histoplasmosis.

Submitted on 11/08/2010 08:12
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Mona Abdel Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Parasitized macrophages. Few plasma cells in the infiltrate. Leishmaniasis is my first diagnosis. Less likely histoplasmosis (usually larger and surrounded with pseudocapsules) and penicillosis (organisms both free and within macrophages).

Submitted on 11/08/2010 02:46
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Sorry for the spelling.. For me there are too small to be Histoplasma

Submitted on 11/08/2010 02:07
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Agree with Marcelita.. Leishmaniasis...For me there are too small por Histoplasma

Submitted on 11/08/2010 02:05
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Marcela Saeb Lima - MSL Dermatopato (Mexico City) Wrote:

WOW!! Leishmaniasis I wouldn´t exclude histoplasmosis

Submitted on 11/08/2010 01:59
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