areas of necrosis (granulomatous inflammation) with 

 multinucleated giant cells. Both lymph nodes and 

 pseudopancreas appear depleted of lymphoid cells, other 

 lymph nodes and spleen do not appear depleted. Congestion 

 and portal fibrosis with mild fatty change in liver and 

 lymphoid aggregates in portal areas and beneath liver 

 capsule. Approximately 10 ulcers in mucosa of distal 

 esophagus, a bleeding ulcer in fundic chamber near junction 

 with forestomach and several longitudinal mucosal erosions 

 in pyloric chamber. 



Lung and lymph node isolates from by both St. Mary's 

 and TVMDL were E. coli (said by TVMDL to be hemolytic) . No 

 bacterial isolates on blood culture (including no acid fast 

 bacilli or anaerobes) — fungal culture still in progress. 

 TVMDL commented that immunocompromise must be considered for 

 a relatively non-pathogenic organism such as E. coli to have 

 caused an acute effect. 

 Pathology suomary: Hematogenous bacterial pneumonia. 



163 



