PathWays Case Study: Nov. 17

Figure 1: Toluidine Blue
Figure 1: Toluidine Blue

Figure 2: H&E
Figure 2: H&E
Figure 3: GMS
Figure 3: GMS

A 52-year-old man from Wisconsin with a past medical history of polymyalgia rheumatica (on long-term steroids) presented after several months of progressive mental status changes.  MRI of the brain showed leptomeningeal enhancement, concerning for an infectious or malignant process.  CSF analysis revealed high protein, low glucose, and greater than 300 nucleated cells (50% lymphocytes and 30% polymorphonuclear cells).

The above images are representative of frozen (Figure 1: Toluidine Blue) and fixed (Figure 2: H&E and Figure 3: GMS) brain biopsy specimens.

 

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Andrew Norgan, M.D., Ph.D.

Andrew Norgan, M.D., Ph.D.
Resident, Anatomic/Clinical Pathology Fellowship
Mayo Clinic

 

 

 

Dr. Bobbi Pritt

Bobbi Pritt, M.D.
Vice Chair of Education, Department of Laboratory Medicine
Consultant, Division of Clinical Microbiology
Mayo Clinic
Associate Professor of Laboratory Medicine and Pathology,
Mayo Clinic College of Medicine

apriljosselyn

April Josselyn

April Josselyn is a Marketing Associate at Mayo Medical Laboratories. She is the editor of Mayo Clinic PathWays and supports corporate communications strategies and internal communications. She has worked at Mayo Clinic since 2012. Outside of work, April enjoys the outdoors and being "hockey mom" for her two sports-crazed boys.

Responses

Thanks so much for teaching us all the answers in the past Dr. Pritt;-)

Always look for fungi in patients on long term steroids.

Interesting case but what are mental changes he suffering ,how this could respond to anti fugal therapy.?may we need anther biopsy latter?

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