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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This patient, had had a laparostomy for recurrent intra-abdominal sepsis following on from crohns disease. She was transferred to another intensive care unit and her dressings changed daily. Shortly after, this dark patches appeared on her liver (as seen here A) and her colon. Superficial biopsies and culture showed A.fumigatus invading liver capsule. She responded to amphotericin B therapy.
B shows patient after treatment.
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Hepatic aspergillosis, pt KO. Repeat CT scan of the liver showing almost complete resolution of lesions on itraconazole therapy.
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Image A. The CT scan of her abdomen had the appearances shown here. She also has small pulmonary nodules. Bioposy of the liver revealed hyphae consistent with Aspergillus.
Image B. She responded well to oral itraconazole therapy.
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This image shows the pelvis of the left kidney filled with fungal balls. Eventually, after failing amphotericin B therapy, she required a nephrectomy. Her case is reported in Davies SP, Webb WJS, Patou G, Murray WK, Denning DW. Renal aspergilloma – a case illustrating the problems of medical therapy. Nephrol Dial Transplant 1987; 2: 568-572.
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Aspergillus keratitis. Good example of Aspergillus keratitis caused by A.glaucus. Usually A.fumitagus and A.flavus are the causes.
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