Case 55
A 33-year-old man returned to the United States after spending four years in Africa, mostly Kenya, working as an agricultural consultant.  He had several parasitic diseases during his four years in Africa.  After returning to the United States, he noticed a painful, swollen lesion with a black center on the top of his right foot.  Initial diagnosis from a health care provider was that the lesion was most likely a plantar wart.  The man did not agree with the physician and obtained a second opinion from a health care provider who suggested that the lesion be biopsied.  The physician surgically removed the affected area and examined the excised tissue.  The physician saw what appeared to be eggs in the tissue.  The entire specimen was sent CDC's reference laboratory for identification of the eggs.  The man did not have any complications from the surgery and the area healed within a few days.  Figure A shows the entire specimen; all other images were taken from the cut surface of the tissue.  Figures B and C were taken with a dissecting microscope equipped with adjustable zoom magnification.  Figure D was taken with a compound microscope using a 5× objective and a fiber-optic light source to provide reflected light.  What is your diagnosis?  Based on what criteria?

A	B

C	D

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Case 56
A 25-year-old man came to the United States from Ghana in 1997 and later joined the U.S. Army.  While in Ghana, the man bathed, swam, did laundry, and drank from the Volta River, which was close to his home.  In early 2000, he began noticing blood in his urine.  He was diagnosed with a venereal disease, treated, and released.  He continued to have symptoms (hematuria) and was seen by a urologist, who ordered a bladder biopsy.  Figures A, B, C, and D show what was found in H & E (hematoxylin and eosin) stained sections of his bladder wall.  What is your diagnosis?  Based on what criteria?

A	B

C	D

Acknowledgement: This case was kindly provided by the U.S. Army.

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