Case #474 – August, 2018

A 27 year-old male presented to his health care provider, after a 10-day work related trip to Ethiopia, with lymphadenopathy of the head and neck, intermittent fevers, and malaise. Thick and thin blood smears were ordered, stained with Giemsa, and examined. Figures A – C show what was found on a stained thick smear in very low numbers. What is your diagnosis? Based on what criteria?

Figure A

Figure B

Figure C

The objects found resemble microfilariae but are actually fungal elements/hyphae and represent contamination of either the stain components or the smear itself. Morphologic features included:

Lack of columns of nuclei.
Septate in structure (best demonstrated in Figures B and C).
No discernable head or tail.

More on Artifacts: https://www.cdc.gov/dpdx/artifacts/index.html

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.