Case #396 – May 2015

A 72-year-old female with a past medical history of congestive heart failure, diabetes, and hypertension was admitted to a local hospital with complaints of progressive shortness of breath. After admission, she became hypoxic and was intubated and placed on mechanical ventilation support. X-rays performed showed pulmonary edema. Bronchial alveolar lavage (BAL) specimens were collected and sent to Microbiology and Hematology for routine work-up. During a cell count, one of the technologists noted what appeared to be motile ciliated or flagellated cells (Figures A and B). An aliquot of the BAL specimen was also stained with hematoxylin-and-eosin (H&E, Figures C and D), in which similar objects were observed. Digital images were taken of the objects of interest and sent to the DPDx Team for diagnostic assistance. What is your diagnosis? Based on what criteria?

This case and images were kindly provided by Sparks Regional Medical Center, Fort Smith, AR.

Images presented in the DPDx case studies are from specimens submitted for diagnosis or archiving. On rare occasions, clinical histories given may be partly fictitious.