A Fatal Case of Disseminated Microsporidiosis Due to Anncaliia algerae in a Renal and Pancreas Allograft Recipient

Abstract

Microsporidiosis is an emerging opportunistic infection in immunocompromised patients. We report a case of fatal disseminated Anncaliia algerae infection in a profoundly immunosuppressed pancreas and kidney transplant recipient.

Keywords: Brachiola; Nosema; immunocompromised; microspo-ridiosis; microsporidia; opportunistic.

Figure 1.

The patient developed several clinical manifestations of disseminated microsporidiosis due to Anncaliia algerae, including (A) ulcerative fingers and (B) oral lesions, as well as ulcerative intranasal lesions and a diffuse papular rash of the lower extremities (not shown). By light microscopic examination, spores were visible using (C) routine hematoxylin and eosin staining, (D) focally positive by Gomori methenamine silver stain, and (E) strongly Gram-positive by Gram stain. (F) The Periodic acid–Schiff stain showed polar dot-like positivity, which is characteristic of microsporidial spores. Spores also were stained bright red using (G) the Ryan blue modified trichrome stain for microsporidia. (H) Electron microscopy showed features of a Nosema-like microsporidia, including large size, a thick cell wall, and a single row of polar filaments (arrow). Scale bars represent 20 µm, except in (H) in which the scale bar is 500 nm.