ALBERT, CYANMDSAMIR, SSHAHMD
A 16-year-old, previously healthy Hispanic American female complained of coughing up small, round “brainlike” structures for the last 6 weeks. The cough was always preceded by a foreign body sensation or “something stuck” in the throat. The episodes occurred 3 to 4 times a week and were often associated with choking. Examination of the oral cavity revealed slightly enlarged tonsils without exudates. The rest of the examination results were normal. During her first visit to our clinic, she handed over 2 small, lobulated masses of white-gray material, which she had expectorated during the last few days (Figure 1). The material was sent for histopathologic examination (Figure 2).
Two masses that the patient expectorated. Both consisted of lobulated, soft, white-gray material that measured 10 mm × 12 mm and 5 mm × 8 mm.
Gram stain highlights coccoid and filamentous structures.
What is your diagnosis?
Al-Tatari H, Abdel-Haq N, Asmar B, Haupert M, Rabah R. Picture of the Month—Quiz Case. Arch Pediatr Adolesc Med. 2006;160(12):1297. doi:10.1001/archpedi.160.12.1297