2013-04-10

Mystery cells, case #15

Who can tell the diagnosis?

A 50-year-old male from the State of Nevada was sailing his boat in the South Pacific for over a month. He would frequently eat raw shellfish and raw fish. He presented to a hospital in Nevada with muscle pain, numbness and headache.

A spinal fluid aspiration was done and the sample was prepared via cytospin run on a CellaVision® DM96 with the Body Fluid Application.

Total nucleated cell count of the spinal fluid: 815 × 10-6/Liter.
Differential white cell count:
32%  Lymphocytes
52%  Eosinophils
3%    Basophils
13%  Monocytes

Please share your suggested diagnosis!

Microscopic images of the spinal fluid:

 

 

 

 

 


 

 

 

35 thoughts on “Mystery cells, case #15”

  1. I’m impressed by all the correct answers. Must be folks from the Pacific Coast. Those of us Easterners learned something today!!
    Sue from Atlanta, GA

  2. increase in eosinophils indicates parasitic infecction. Due to shellfish aconsumption, the intermediate host of parasite.probably Anisakiasis sp.

  3. increase in momocytes indicates parasitic infecction. Due to shellfish consumption, the intermediate host of parasite.probably Anisakiasis sp

  4. It is eosinophilic meningitis caused by parasitic infection. In South Pacific, the most common endemic parasite is Angiostronglyes cantonensis.

  5. Eosinophilia suggests he picked up a parasite from consumming raw fish and shellfish. My first guess would be Angiostrongyliasis due to the region and CNS involvement.

  6. Angiostrongylus canatensis, the rat lungworm larvae causes CSF eosinophilia after ingesting raw fish or shellfish from South Pacific area.

  7. Elevatet WBC count – dominated of eosinophils .
    Could be:
    parasitic infections associated with eosinophilic meningitis.
    Because he has been eating raw fish.

    Thank You for an interesting case.

  8. The photos show some lymphocytes and mococytes/macrophages – dominated of eosinophils.
    Could be parasitic infections associated with eosinophilic meningitis, because he has been eating raaw fish.
    Thank You for an interesting case. Nice photos of eosinophils.

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