A Diagnosis Made in Vein

PHOTO QUIZ Philip A. Mackowiak, Section Editor

A Diagnosis Made in Vein (See pages 609–610 for the Answer to the Photo Quiz.)

Biopsy specimen of the bladder wall sessile polypoid lesion (hematoxylin-eosin stain, original magnification 340).

A 38-year-old man presented to the University of Kentucky Medical Center for evaluation of a 2-month history of dysuria and intermittent macroscopic hematuria. Approximately 1 week prior to the development of these symptoms he had immigrated from the Republic of the Congo. The patient had a past medical history significant for asymptomatic hypertension and a positive purified tuberculin skin test result, which was treated with isoniazid. A urinalysis test was normal with the exception of hematuria (69 red blood cells per high-power field). A complete blood count revealed a white blood cell count of 5400 cells/lL with 40% neutrophils, 41% lymphocytes, 10% monocytes, and

9% eosinophils (refernce range, 1%–7%). The patient underwent ultrasonography of the kidneys and urinary bladder that demonstrated a posterior bladder wall 14 3 6-mm2 sessile polypoid lesion. Urinary cystoscopy with biopsy was obtained for histological and microbiological examination (Figure 1). What is your diagnosis? Clinical Infectious Diseases 2011;53(6):575 Ó The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@ oup.com. 1058-4838/2011/536–0013$14.00 DOI:10.1093/cid/cir416

PHOTO QUIZ

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CID 2011:53 (15 September)

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Figure 1.