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Case Study: April 2013
History
- 10 year old female
- Recent visit to South-East Asia
- Gives a very clear history of being bitten on the eyebrow and earlobe by ‘black flies’
- Develops ulcerated lesions at site of fly bites
- Also has post-auricular lymphadenopathy on side of earlobe lesion
- Biopsy of eyebrow lesion and lymph node
- Fig 1 and 2 – skin lesion
- Fig 3 is lymph node
Questions
- What is the histological reaction pattern seen in Fig 1 and 2?
- What is the differential diagnosis?
- What does Fig 3 of the lymph node show?
- What is the most plausible diasgnosis?
Click to show answers
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- Necrotising granulomas / granulomatous inflammation
- Infection (myocbacteria, fungi, parasitic mainly)
- A granulomatous lymphadenitis.
- Leishmania given the clear history of fly bites. Despite the absence of organisms in the macrophages, the PCR performed on fresh tissue was positive.
