Date: 26 November 2013
Transverse sections through the thorax of a patient with AIDS, hepatitis C and a left tempero-parietal cerebral lymphoma. His CD4 cell count was 45 x 106 / l. The lymphoma was proven by biopsy after a poor response to anti-toxoplasma therapy. He was given dexamethasone to cover the surgery and then developed diabetes mellitus. He did not receive chemotherapy for his lymphoma but did have 2 cerebral radiotherapy treatments (1.8 Gy each). Three weeks after the biopsy he developed dyspnoea and fever. Shortly after this he developed a right-sided hemiparesis, became comatose and died 2 days later.Autopsy showed a cerebral lymphoma and pulmonary and renal aspergillosis. Aspergillus nidulans was recovered from cultures of lungs and kidney.
Copyright:
Images submitted by Dr. Cornelia Lass-Floerl, University of Innsbruck – Institute of Hygiene; the case team includes: Dr. Mario Sarcletti, Dr. Alfons Stöger and Prof. Hans Maier all at the University of Innsbruck.
Notes: n/a
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Corneal ulcer – gram stain. Corneal scrapings were taken from a 67 yr old farmer presenting with a corneal ulcer of the right eye. A piece of vegetable matter was embedded in the cornea and scrapings were done. Gram stain (500x magnification) showed numerous septate hyphae. Cultures grew a small amount of A fumigatus.
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Corneal ulcer – gram stain. Corneal scrapings were taken from a 67 yr old farmer presenting with a corneal ulcer of the right eye. A piece of vegetable matter was embedded in the cornea and scrapings were done. Gram stain (500x magnification) showed numerous septate hyphae. Cultures grew a small amount of A fumigatus.
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Corneal ulcer – gram stain. Corneal scrapings were taken from a 67 yr old farmer presenting with a corneal ulcer of the right eye. A piece of vegetable matter was embedded in the cornea and scrapings were done. Gram stain (500x magnification) showed numerous septate hyphae. Cultures grew a small amount of A fumigatus.
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Aspergillus keratitis. Central lesion in aspergillus keratitis following a corneal foreign body which made a good response to topical treatment alone, albeit over 2 months intensive treatment.
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Aspergillus keratitis. B- Severe central aspergillus infection with a “cheesey†looking area of the lesion and hypopyon (fluid level of inflammatory cells in the anterior chamber)
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Aspergillus keratitis. A- Severe aspergillus infection with large area of corneal ulceration and deep stromal involvement
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Candida keratitis. Focal candida keratitis as an unusual cause of a suture related infection following corneal transplantation for non infective indication
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Candida keratitis. Subacute onset of candida keratitis in a young adult in whom dust blew into her eye in Greece. A slightly “feathery†edge to stromal involvement is suggestive of fungal infection
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Aspergillus endopthalmitis. Temporal necrosis due to Aspergillus endopthalmitis as part of disseminated disease. No evidence of vitritis. Systemic treatment essential.
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Aspergillus endopthalmitis. Large scarred area of the choroid following healing after Aspergillus endopthalmitis
