NQ-088 Answer: (D) Cytomegalovirus

Pathology of the case: In essence, what is being shown here is a chronic granulomatous inflammation with Langhans giant cell (arrow) formation.

 

The specimen was obtained from the mass of a thoracic spine. The adipose cells strongly suggest that the specimen is not taken from the brain or spinal cord where mature adipose tissue is not normally found. There are many "globules" of epithelioid cells surrounded by lymphocytes. These structures are known as granuloma and this is a chronic granulomatous inflammation. A Langhan's giant cell is present (arrow). This type of histopathologic changes are seen in mycobacterial infection and also in fungal infection. An acid fast stain on this case revealed scant acid fast positive bacilli consistent with mycobacterial. Bacterial culture results in this case revealed Mycobacteria tuberculerosis.
 

All of the choices being listed here, except cytomegalovirus, are known to be produce granulomatous inflammation.