Date: 11 July 2016
Patients has history of ABPA complicating long standing asthma. His total IgE has fluctuated between 2,200 and 4,600 KU/L, his Aspergillus IgE between 36.3 and 65.4 kAU/L and Aspergillus IgG from 87-154 mg/L. He has been taking long term itraconazole.
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Notes:
The CT scan (3 cuts from the same scan in 2012) shows background paraseptal and centrilobular emphysema and the distribution of the varicoid bronchiectasis (i.e. upper lobe predominant and central) is consistent with ABPA. There are no areas of consolidation or evidence of interstitial lung disease. Several fluid levels are seen within the airways together with bronchial wall thickening throughout the right hemithorax. There is almost no evidence of exudative small airways disease (i.e. no small airway impaction).
The chest Xrays show mild cardiomegaly. There are background chronic interstitial changes of a coarsened reticulonodular pattern, with an area of more prominent pulmonary fibrotic change in the right mid zone. Minor apical thickening noted.
Images library
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Mucous plug examined by light microscopy with KOH, showing a network of hyaline branching hyphae typical of Aspergillus, from a patient with ABPA.
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Corneal scraping stained with lactophenol cotton blue showing beaded septate hyphae not typical of either Fusarium spp or Aspergillus spp, being more consistent with a dematiceous (ie brown coloured) fungus
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Corneal scrape with lactophenol cotton blue shows separate hyphae with Fusarium spp or Aspergillus spp.
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A filamentous fungus in the CSF of a patient with meningitis that grew Candida albicans in culture subsequently.
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Transmission electron micrograph of a C. neoformans cell seen in CSF in an AIDS patients with remarkably little capsule present. These cells may be mistaken for lymphocytes.
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India ink preparation of CSF showing multiple yeasts with large capsules, and narrow buds to smaller daughter cells, typical of C. neoformans
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PAS stain. An example of Aspergillus fumigatus.
(PAS-stained) in a patient with chronic granulomatous disease showing a 45 degree branching hypha within a giant cell. Rather bulbous hyphal ends are also seem, which is sometimes found inAspergillus spp. infections, histologically. (x800)
