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Diagnose This (November 2, 2021)

chronic active antibody-mediated rejection
In a renal transplant recipient, these findings would be most consistent with…...?     ​ ​   ​   ​ ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​   ​ ​   ​ ​   ​ ​   ​ ​  ...

Halloween 2021!

lab halloween shrek characters
Boo to you from our crew! From seeing Shrek characters to a Waffle House waffle, we’ve had a great time celebrating Halloween.    

Multiple Mononeuropathy

Multiple mononeuropathy
This 25-year-old patient presented with clinical features of mononeuropathy multiplex (multifocal neuropathy). Serologic studies showed normal inflammatory markers. The nerve biopsy was performed to evaluate for vasculitis. The patient was treated with steroids prior to biopsy.   Based on the following images (see Figures 1 – 5) what additional testing would be most warranted? A. ANCA B. Del/Dup PMP22 C. Amyloid subtyping D. Hemoglobin A1C   Note the two axons that appear enlarged (thick arrows) compared to other myelinated axons within the nerve fascicle   Note the several axons have thicker myelin sheaths (thick arrows) compared to other large-diameter myelinated...

Pontine Lesion

Pontine Lesion, large cystic lesion filled with grumous material within the right basis pontis
  This middle-aged patient presented with left-sided upper and lower extremity weakness. MRI demonstrated a 2.5 cm cystic ring-enhancing lesion in the pons. The patient’s condition deteriorated and they expired.  An autopsy was performed.   Which of the following would best complete the following sentence based on the gross (Figure #1) and microscopic (Figures #2 and #3 ) findings?  The patient has a history of ______. A. Bacterial sepsis B. Large hilar lung mass C. Multiple sclerosis D. Eating raw pork   Answer: Large hilar lung mass Figure #1 shows large cystic lesion filled with grumous material within the right...

Mycobacterial Infection

Mycobacterial Infection
Hematoxylin and eosin FFPE 100x original magnification Hematoxylin and eosin FFPE 100x original magnification   Acid Fast Stain (Kinyoun) FFPE 1000x oil immersion   This 45-year-old patient presented to the emergency department with left thigh and buttock pain of four months’ duration, and two weeks of fever (105oF) and chills. The patient's past medical history is significant for autoantibody-positive rheumatoid arthritis treated with mycophenolate mofetil and steroid, and recent findings of focal central disc herniation at L5-S1. The patient is reported to have traveled to Asia and India. Chest X-ray showed mild bibasilar atelectasis. MRI showed avascular necrosis of the...

Vasculitis

ANCA-Associated Vasculitis, anti-neutrophil-cytoplasmic antibodies (ANCA) testing
Hematoxylin and eosin; 200x and 400x original magnifications   This 60-year-old patient presented with fevers and bilateral leg myalgias of one month’s duration. Laboratory studies demonstrate elevated ESR (120) and normal CPK. On physical examination, the patient had pain upon palpation of both calf muscles. Muscle biopsy was performed. Given the clinical history and features seen in the image, what additional laboratory test results would be best to request? A. ANCA B. Stool ova and parasites C. C-reactive protein D. RPR   Answer: ANCA The image shows the circumferential presence of mononuclear histiocytes within the wall of a small artery...