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August 2018 — Anatomic Pathology

The patient is a 78-year-old woman with a medical history significant for chronic kidney disease stage III, microscopic hematuria, and proteinuria. Investigations show a serum creatinine of 2 mg/dL and a 24-hour urine protein of 3,900 mg/24 hours.

Image 1: Mesangial expansion with PAS positive material.
Image 2: Immunofluorescence positivity (2+) for IgG in a smudgy mesangial staining pattern.
Image 3: Mesangial fibrillar deposits on EM.
Image 4: Extracellular and mesangial DNAJB9 deposition

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Kriselle Maris (Kriselle) Lao, M.D.
Former Resident, Renal Pathology
Mayo Clinic
Mariam (Priya) Alexander, M.D.
Consultant, Pathology
Mayo Clinic
Associate Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

August 2018 — Infectious Disease

A 65-year-old woman was admitted to a hospital in Mason City, Iowa, due to a two-month history of malaise and migraines that had been progressively worsening. She also reported vertigo, light sensitivity and blurred vision, hearing loss, and pulsatile tinnitus, although she did not report any fevers or chills. Her past medical history is notable for hypertension and smoking one pack of cigarettes per day. Her daughter owns hobby chicken coops, and the patient admits that she works with her daughter’s chickens. She was transferred to Mayo Clinic due to bilateral papilledema, elevated intercranial pressure, and elevated cell counts in cerebrospinal fluid (CSF). A Gram stain of CSF (pictured) shows lymphocytic pleocytosis (green arrows) and a cluster of organisms in the center.

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Sarah Jung, Ph.D.
Fellow, Clinical Microbiology
Mayo Clinic
Audrey Schuetz, M.D.
Senior Associate Consultant, Clinical Mirobiology
Mayo Clinic
Associate Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

August 2018 — Laboratory Genetics

A 25-year-old female presented with extreme malnourishment (BMI=9). Her nutrition has been suffering due to severe gastroparesis along with cyclic vomiting and food intolerance. Her symptoms began when she was approximately 19 years old and multiple gastrointestinal assessments have failed to result in a diagnosis. Analysis of urine organic acids revealed elevated levels of uracil and thymidine (figure 1), which were confirmed independently by dedicated purine/pyrimidine analysis. Molecular analysis revealed homozygous pathogenic mutations in the TYMP gene.


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Adam Guenzel, Ph.D.
Fellow, Clinical Biochemical Genetics
Mayo Clinic
Silvia Tortorelli, M.D., Ph.D.
Consultant, Laboratory Genetics/Genomics
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

August 2018 — Gastrointestinal

A 51-year-old male with no significant past medical history underwent screening colonoscopy. A 0.5 x 0.4 x 0.3 cm transverse colon polyp was seen and excised during colonoscopy. A biopsy was performed.

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Kadijeh (Narges) Jahanseir, M.D.
Resident, Anatomic Pathology
Mayo Clinic
Tsung-Teh Wu, M.D., Ph.D.
Consultant, Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine
Erika Fetterman

Erika Fetterman

Erika Fetterman, Editorial Assistant at Mayo Medical Laboratories, supports internal and client-facing communications.