Polarizable Material as a Clue

Abstract

A healthy 22-year-old college student presented with 2 itchy, painful scalp nodules associated with intermittent lancinating pain. Lesions appeared after an alleged mosquito bite during his vacation in Belize. He initially presented to an emergency department and was diagnosed with cellulitis unresponsive to treatment with antibiotics and antifungal medication. FIGURE 1. Physical examination of the scalp reveals 2 warbles--boggy plaques with a central punctum and intermittently draining serosanguineous fluid. Zsolt B. Argenyi, MD, Section EditorFIGURE 2. Hematoxylin and eosin stain of the punch biopsy shows polarizable foreign material with fibrinous exudates, a foreign body reaction, and chronic inflammation.FIGURE 3.Hematoxylin and eosin stain of the excisional biopsy shows a cavity with inflammatory infiltrate and a bright refractile material-similar to what was seen in the punch biopsy specimen-a foreign object surrounded by eosinophils, and a focal granulomatous inflammation.

Pulse granuloma of the lip: morphologic clues in its differential diagnosis

“…The only birefringent area was a part of the mouth apparatus, which exhibited a yellowish birefringence, as well as its intestinal contents. These findings contrast with claims in the literature regarding the role of polarization as an indicator in the diagnosis of myiasis . In our opinion, the birefringence of amorphous pigmented fragments points to vegetable pericarp rather than to animal parts.…”

“…Such birefringency could make the unwary think of the possibility of the fragmented cuticle of a maggot. In fact, polarizable material has been presented in the literature as supportive for the diagnosis of cutaneous myiasis . Misdiagnosis can be avoided if one pays attention to the cuticle layers in the maggot (epi, exo and endo), which differ from the pericarp structures shown here.…”

“…However, other vegetable parts, such as the pericarp, which is pigmented and may mimic the cuticle or the mouth apparatus of the maggot, are hardly ever mentioned. Moreover, the pericarp is birefringent when examined under polarized light, and this evidence of polarizable material has been presented in the literature as an indicator in the diagnosis of myiasis . Myiasis can also be a consideration in the clinical differential diagnosis in cases like the current one, because the lip is an uncommon site for a pulse granuloma but has occasionally been the site of involvement by myiasis.…”

Polarizable elements in scabies infestation: a clue to diagnosis

“…Corneocytes of the stratum corneum are polarizable and Gonzalez‐Serva et al have reported polarizable crystals in sebum raising the possibility that the intraabdominal birefringent material in both scabies and Demodex scybala may be related to an intrinsic characteristic of the mites' diet. The polariscopic features of other parasitic organisms such as tungiasis or larva migrans have not been described, although the mouth hooks, larval spiracles and spines of the intradermal parasite, Dermatobia hominis , are reportedly polarizable . As the size and location of these parasites are very different than scabies, they are not typically considered in the same differential diagnosis.…”

Myiasis

“…When the larva is well conserved, a large central tubular cavity; the digestive tube; the respiratory tract, composed of smaller tubular structures; a circulatory system; and the pigmented posterior respiratory spiracle can all be identified (26, 56). Polarized light microscopy may show a bright retractile material (328).…”