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Infectious Disease Pathology
Monday, March 26, 2007, 7:30 PM
Convention Center 4
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Moderator:
GARY W. PROCOP
University of Miami School of Medicine
Miami, FL
Disclosure: The speakers have indicated they have nothing to disclose.
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for Text and References
Submitted by: Sherif Zaki - Centers for Disease Control, Atlanta, GA
A previously healthy 4 year old female from New York had a two day history of abdominal pain and vomiting. She was not seen by a medical provider. The parents last saw the child alive on the early morning of March 1, 2004 but found her dead in bed later that morning. No information on travel history or other significant exposure could be obtained.
Case 1 - Slide 1
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Case 1 - Slide 2
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Case 1 - Figure 1
Sections of the bronchi and trachea show focal denudation of epithelium, and submuscosal edema, congestion, and abundant inflammatory cell infiltrates comprised of lymphocytes, macrophages, and occasional eosinophils. Abundant detached epithelium admixed with necrotic debris and inflammatory exudates are present in the lumens of these airways.
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Case 1 - Figure 2
Sections of the bronchi and trachea show focal denudation of epithelium, and submuscosal edema, congestion, and abundant inflammatory cell infiltrates comprised of lymphocytes, macrophages, and occasional eosinophils. Abundant detached epithelium admixed with necrotic debris and inflammatory exudates are present in the lumens of these airways.
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Case 1 - Figure 3
The lungs show congestion, multifocal peribronchiolar and perivascular inflammatory cells infiltrates, and mixed intraalveolar collections of inflammatory cells.
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Case 1 - Figure 4
The heart shows focal mild lymphocytic myocarditis.
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Case 1 - Figure 5
Abundant immunohistochemical (IHC) staining of influenza B antigens was observed in the nuclei and cytoplasm of respiratory epithelial cells lining the trachea, bronchi, and bronchioles, and in the detached necrotic debris within the lumens of these airways.
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for Text and References
Submitted by: Michael L. Wilson - Denver Health Medical Center, Denver, CO
A 30 year-old pregnant female at 15 weeks gestation presented with fevers, chills, and right lower quadrant pain. The clinical diagnosis was pelvic inflammatory disease versus acute appendicitis. The patient underwent laparotomy and appendectomy as the appendix was visibly inflamed. Thre was also visible inflammation of the right fallopian tube and ovary. The pathologic diagnosis was acute periappendicitis with a comment that the inflammation was peri-appendiceal only and thus a source of infection elsewhere in the abdomen or pelvis should be considered. Two and one-half weeks later the patient presented with vaginal bleeding and reported a continuation of fevers and chills since the appendectomy. There was no evidence of a surgical site infection. The patient went into spontaneous labor and delivered a non-viable fetus. Images 1-2 are of placenta; images 3-5 are of appendix, all H&E at 200X magnification.
Case 2 - Figure 1
Appendix, serosal surface at left, showing marked chronic inflammation and serosal thickening.
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Case 2 - Figure 2
Appendix, periappendiceal soft tissues show non-necrotizing granuloma.
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Case 2 - Figure 3
Appendix, periappendiceal soft tissues show non-necrotizing granuloma.
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Case 2 - Figure 4
Placenta, focal acute intervillositis adjacent to an area of necrosis (not shown in image).
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Case 2 - Figure 5
Placenta, focal necrosis with acute inflammation.
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for Text and References
Submitted by: Ann M. Nelson - Armed Forces Institute of Pathology, Washington, DC
Penis, bx:
57 y/o man with AIDS
- CD4 =243 (was 20)
- Chronic, severe penile ulcerations
- Hx of HSV penile foreskin
- Empiric RX for HSV, fungi - no improvement
- On HAART: Lopinavir, Efavirenz, Abacavir, Tenfovir
- Low HIV viral loads (previously >750,000 copies)
Case 3 - Slide 1
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Case 3 - Figure 1
Penis, biopsy (HE 4x) shows ulceration and a diffuse sub-cutaneous infiltrate.
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Case 3 - Figure 2
Penis, biopsy (HE, 10x) higher power showing the edge of the ulceration with acute inflammation.
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Case 3 - Figure 3
Penis biopsy (HE 40x) High power of infiltrate show a mixed inflammatory infiltrate of lymphocytes, plasma cells and eosinophils. Note the epithelial cells with viral inclusions in the left side of the image
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Case 3 - Figure 4
Penis biopsy (HE 40x) The lymphocytic infiltrate seen here raised concern of a lymphoproliferative process. Immunostained revealed a predominance of CD3+/CD8+ T-cells.
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Case 3 - Figure 5
Penis biopsy (HE 40x) Edge of ulcer showing necrosis, hemorrhage and a large cell at the surface with smudged nuclear chromatin. Immunostaining for HSV 1,2 was reactive in this cell.
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for Text and References
Submitted by: Carol Farver - Cleveland Clinic Foundation, Cleveland, OH
The patient is a 57 year-old white female, 4 months status post single lung transplantation (donor/recepient CMV+) for emphysema secondary to smoking, who presented with increasing shortness of breath which progressed to complete opacification and diffuse infiltration of the transplanted lung by chest X-ray. The patient was taken to open biopsy due to a rapidly declining respiratory status.
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