Resident Pathologist: Ronaldo Abueg, M.D.

Pathologist: Debbie de la Fuente, M.D., F.P.S.P

 Adult Male

 Extremities: pale with rigor mortis changes

 Lungs: External surface covered with thin

fibrinopurulent material with focal areas of
thickening which appears fibrous when cut
 Lungs
Interstitial
pneumonia
with severe
Superimposed
Focal areas of
necrosis and
bronchopneumonia
hemorrhages Polymorphonuclear
infiltrates
Lungs
Hemorrhagic infarcts
Hyphae within the blood
vessels
Recent organizing
thrombi
Septated hyphae wih
mycelia
Lungs
Acute Respiratory
Distress Syndrome
Esophagus
Focal areas of
erosions mostly
on
distal third
 Stomach: blood all over mucosal surface
with focal areas of erosions, antrum
severely eroded
Small Intestines

Severe infestation of
adult worms measuring
2.0 to 4.0 mm. Foreign
Worms in Body giant cells around
duodenum Infested crypts
Small Intestines
Severe infestation of
adult worms measuring
2.0 to 4.0 mm. Foreign
Body giant cells around
Infested crypts

Worms in
jejenum
 Large intestines: severe congestion with
occasional ulcers and infiltrated mainly by
mononuclear cells. Lymph vessels dilated
causing lymphangiectasias

 Spleen: normal

 Liver: moderate fatty changes

 Heart: occasional hypertrophy of muscle
fibers with focal interstitial fibrosis

 Kidneys: except for congestion, microscopic

sections were normal

 Adrenals: Unremarkable
 Brain: areas of necrosis with histiocytic
infiltrates at the region of pontine, nuclei
and longitudinal fibers of the cortico-spinal
and cortico-bulbar tract with small recent
hemorrhages of the pons
 1.MASSIVE GASTROINTESTINAL
HEMORRHAGE (2 LITERS) SECONDARY TO
CHRONIC ULCERATIONS, DISTAL THIRD OF
ESOPHAGUS, STOMACH, SMALL AND LARGE
INTESTINES

 2. MASSIVE ROUNDWORM INFESTATION,

DUODENUM AND JEJENUM (CAPILLARIASIS)
 3. ACUTE RESPIRATORY DISTRESS SYNDROME
SECONDARY TO SEVERE BRONCHOPNEUMONIA
WITH PULMONARY MYCOTIC (MUCORMYCOSIS)
INFECTION AND HEMORRHAGIC INFARCTS

 4. RECENT SMALL HEMORRHAGES, PONS WITH

AREAS OF RECENT NECROSIS AND HISTIOCYTIC
INFILTRATES AT THE REGION OF PONTINE
NUCLEI AND LONGITUDINAL FIBERS OF THE
CORTICO-SPINAL AND CORTICO-BULBAR TRACT
 Caused by the nematode Capillariasis
philippinensis
 Transmitted via ingestion of bird-eating

fresh or brackish water fish

 Infection has an insidious onset with

nonspecific abdominal pain and diarrhea

 Invasive larvae cause intestinal

inflammation and villus loss

 Subsequent autoinfection can lead to a
severe wasting syndrome –
hypoproteinemia, hypoalbuminemia,
hypocholesterolemia, hence the name
Wasting disease

 If left untreated, progressive autoinfection

can lead to protein-losing enteropathy,
severe malabsorption and ultimately to
death from cachexia, heart failure or
superinfection.
Ingestion of fish with Capillaria
Chronic Steroid use

Diarrhea, GIT infestation

and wasting disease

Superinfection and immunosuppression Massive GI bleeding

Fungal pneumonia, ARDS

Multiple Organ Failure

DEMISE OF THE PATIENT