Photo Quiz: Hematuria in a 26-Year-Old Male with AIDS

Abstract

A 26-year-old male with HIV/AIDS and a CD4 count of Ͻ50 cells/mm 3 presented to a routine follow-up visit with darkening of his urine, which had been occurring for several days. The patient was born in Ghana and lived there for the first 10 years of his life. He returned to Ghana in 2013 and recalls swimming in freshwater there. He was compliant with his medications and had had no opportunistic infections to date. As the problem was believed to be related to possible exercise-induced hematuria, no recommendations were made; however, a urine sample was collected for cytology examination to rule out possible malignancy and for urine culture to rule out infection. The cytology examination reported no malignant cells, but an organism was present (Fig. 1A). The urine culture was negative. The patient returned with worsening gross hematuria and was then referred to a genitourinary subspecialist. The results of the computed tomography urogram revealed a 1.0-cm soft tissue nodule protruding into the urinary bladder with foci of calcification, concerning for a bladder mass. Cystoscopy examination showed multiple tan white papules, predominantly at the trigone, and a 1.5-cm mass in the left lateral wall. Multiple tissue biopsy specimens were obtained from the bladder wall and trigone (Fig. 1B), which confirmed the diagnosis, and treatment was initiated. Citation Jing J, Hanna MG, Zhang DY, Szporn AH, Dingle TC. 2018. Photo Quiz: Hematuria in a 26-year-old male with AIDS. J Clin Microbiol 56:e00724-16. https://doi.org/10.1128/JCM .00724-16.

Rhabditiform larvae of Strongyloides stercoralis hatching in a bronchoalveolar lavage specimen

“…They are quite different from the familiar eggshells of Schistosomes, which are yellow-orange with a Papanicolaou stain, relatively rigid (maintaining a similar size and shape post-hatching) and display a single lateral or terminal spike or no spike at all, depending on the species. 9 (Figure 3) In our Papanicolaou-stained direct smears, the eggshells of Strongyloides stercoralis present as ovoid and transparent blue-lavender structures with faint cross-striations (when the larvae are unhatched or in the process of hatching). After hatching, the eggshells collapse to a linear structure in one of two different forms ( Figure 1A,B).…”