Case #163 – September, 2005

A 45-year-old man was admitted to a local emergency room in a comatose state after apparently having a heart attack. The man never regained consciousness and expired the next day. His patient history, gathered from his wife, included high blood pressure and high cholesterol levels as well as complaints of abdominal pain, intermittent diarrhea, noticeable weight loss, frequent headaches, and occasional shortness of breath for the past 5 months. His wife stated that he had been working abroad for one year in the Philippines and had just returned home for a one-week visit. An autopsy was performed to determine the cause of death. Figure A shows an image captured from a hematoxylin and eosin (H & E) stained slide of a section of intestinal tissue. Although not the cause of the man’s death, what is your diagnosis of this incidental finding? Based on what criteria?

Figure A

This case demonstrated the incidental finding of eggs of Capillaria spp. in the intestinal tissue. Diagnostic features included:

thick-shelled eggs with prominent polar plugs found in the mucosa of the intestine, which is consistent with Capillaria spp.
unembryonated eggs.

Eggs of Trichuris trichura also have prominent polar plugs, however the polar plugs of some Capillaria spp. tend to be flattened giving the eggs a more quadrate form; this can be seen in some of the eggs (black arrows, Figure A). The shells of the Capillaria spp. eggs shown in Figure A were also striated (faintly visible in a few eggs in the image). The patient’s travel history was also consistent with acquiring capillariasis, although it would not be a factor that would allow trichuriasis to be ruled out since this disease is found worldwide.

Figure A