Date: 26 November 2013
22/09/08 This chest radiograph shows bilateral hazy diffuse airspace disease predominating in the lower lungs with subtle nodularity in upper zones.
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Notes:
A 33 year old known Chronic Granulomatous Disorder (CGD) male presented to A&E in respiratory distress and admitted with severe bibasal pneumonia. He had been laying mulch in his garden. He had not been taking any prophylactic antifungal agents. Oxygen therapy was commenced in conjunction with IV bacterial and fungal treatment with Amphotericin B (Fungizone ®). Further consultation and an adverse reaction to the administration of Fungizone ® led to a switch to IV Voriconazole 300mg BD. The patient tested positive for aspergillus antibodies in serum. The patient declined a bronchoscopy, responded well to IV voriconazole and was discharged home 2 weeks post admission on maintenance voriconazole.
Images library
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Title
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Allergic Aspergillus Sinusitis -Patient AM. D – Marked involvement of ehmoidal air cells on the right , together with the inferior aspect of the sphenoid sinus. The left side is almost clear of disease.
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Further details
Image 1. The chest x-ray shows extensive bilateral nodular disease, most consistent with a fungal infection, or possibly tuberculosis. He was treated with a bucket face mask with 80% oxygen and voriconazole.
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A Colonies on MEA +20 % sucrose after 2 weeks; B ascomata, x 40; C conidiophore of Aspergillus glaucus x 920;D conidiophore of Aspergillus glaucus x920 E. portion of ascoma with asci x 920. F ascospores x2330.
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Scanning electron micrographs of A. fumigatus conidia of transformants rodB-02 (b). Size bar, 100 nm.
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Scanning electron micrographs of A. fumigatus conidia of the wild-type G10 strain (a). Size bar, 100 nm.
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Scanning electron micrographs of A. fumigatus conidia of rodA rodB-26 (d).Size bar, 100 nm.
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