Walls Timothy, Cavuoti Dominick, Channabasappa Nandini, Yang Mary, Southern Paul, Gill Michelle A, Park Jason Y
1 University of Texas Southwestern Medical Center, Dallas, TX, USA.
2 Children's Health, Children's Medical Center, Dallas, TX, USA.
Int J Surg Pathol. 2018 Aug;26(5):475-478. doi: 10.1177/1066896917749929. Epub 2017 Dec 26.
We present a case of a 4-year-old girl with abdominal angiostrongyliasis who presented with persistent fevers, hepatosplenomegaly, acute abdominal pain, and eosinophilia. Computed tomography scan identified thickening of the ascending colon with a narrowed lumen. Endoscopic evaluation revealed ulcerations and erythema in the ascending colon. The microscopic findings in biopsies included active chronic inflammation with prominent eosinophils and granulomas. A subset of granulomas contained the eggs of Angiostrongylus costaricensis. The definitive method of diagnosing A costaricensis is histology; peripheral blood serology has low specificity and the stool from infected patients does not contain eggs or larvae. Pathologists from endemic regions (Central and South America) are familiar with the typical histologic changes; however, because of increasing global travel, all pathologists should become familiar with A costaricensis, which may mimic common gastrointestinal diseases such as Crohn's disease, appendicitis, and Meckel's diverticulum.
我们报告一例4岁患腹部管圆线虫病的女孩，其症状为持续发热、肝脾肿大、急性腹痛和嗜酸性粒细胞增多。计算机断层扫描显示升结肠增厚，管腔狭窄。内镜检查发现升结肠有溃疡和红斑。活检的显微镜检查结果包括伴有显著嗜酸性粒细胞和肉芽肿的活动性慢性炎症。一部分肉芽肿含有哥斯达黎加管圆线虫卵。诊断哥斯达黎加管圆线虫的金标准方法是组织学检查；外周血血清学特异性低，感染患者的粪便中不含虫卵或幼虫。来自流行地区（中美洲和南美洲）的病理学家熟悉典型的组织学变化；然而，由于全球旅行的增加，所有病理学家都应该熟悉哥斯达黎加管圆线虫，它可能会模仿常见的胃肠道疾病，如克罗恩病、阑尾炎和梅克尔憩室。
