Intramural Ova of Enterobius vermicularis in the Appendix—An Egg-Topic Location!

We report an unusual case of appendicitis in a 9-year-old girl in whom the wall of the appendix contained necrotizing granulomas, as well as eggs of Enterobius vermicularis. Although luminal E vermicularis adult parasites are commonly identified in the appendix and luminal eggs are occasionally seen, intramural worms and eggs are rare. We are unaware of earlier reports of ectopic intramural eggs in the appendix. It is important to and make a correct diagnosis, as both, the patient, as well as the family should be treated for enterobiasis.

Characteristics of subclinical Mycobacterium avium ssp. paratuberculosis infection in a captive white-tailed deer herd

Paratuberculosis (Johne’s disease) is caused by Mycobacterium avium ssp. paratuberculosis (MAP), and affects both domestic and wild ruminants, including cattle, goats, sheep, and deer. In cattle, most infections occur during calfhood followed by a prolonged incubation period of 1–2 y or more before cows shed culturable numbers of MAP bacilli in their feces. As disease progresses, infected animals develop protein-losing enteropathy, intractable diarrhea, and weight loss. In a cohort of 32 clinically normal deer from a herd with a history of periodic clinical paratuberculosis, we found that subclinical infection was characterized by high rates of infection, common involvement of mesenteric lymph nodes, minimal lesion formation, few intralesional acid-fast bacilli, and low-level fecal shedding of MAP. The characteristics of subclinical paratuberculosis in white-tailed deer resemble those of cattle and red deer, although microscopic lesions were less common in subclinical deer than reported for subclinical cattle, and we did not see necrotizing granulomas as described in subclinical red deer and elk.

Sarcoidosis

Sarcoidosis is a systemic disease of unknown etiology, characterized by noncaseating epithelioid cell granulomas. Patients with sarcoidosis are frequently asymptomatic and may be diagnosed incidentally because of an abnormal imaging study. Sarcoidosis is a diagnosis of exclusion that warrants pathological confirmation in all cases. The distribution of granulomas in the lungs is characteristic and correlates with imaging findings; non-necrotizing granulomas classically exhibit a perilymphatic distribution. On chest radiography, the presence of bilateral hilar and right paratracheal lymphadenopathy, particularly in a young asymptomatic patient, should raise the possibility of sarcoidosis. On CT, a perilymphatic distribution (peribronchovascular, subpleural, septal) of abnormalities in the appropriate clinical context is highly specific for sarcoidosis.