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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Pt FT. Autopsy appearance of the trachea, after the adherent pseudomembrane had been removed, revealing confluent ulceration superiorly with small green plaques of Aspergillus growth on the trachea inferiorly.
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This view was obtained in a lung transplant recipient at bronchoscopy. Aspergillus fumigatus was grown from bronchial lavage but invasion was not demonstrated on bronchial biopsy. Symptoms improved with itraconazole therapy and abnormal appearances had resolved within 2 weeks.
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Bronchoscopic view of Aspergillus tracheobronchitis. Bronchial lavage revealed hyphae in microscopy and cultures grew A.fumigatus. This man had received a lung transplant a few weeks before. Invasion of mucosa, but not cartilage, was demonstrated histologically. He responded rapidly to oral itraconazole.
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This view from indirect laryngoscopy illustrates bilateral lesions on the larynx that on biopsy were shown to be due to Aspergillus. This is a rare disease in non-immunocompromised patients.
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Bronchoscopic view of a deep bronchial ulcer in a lung transplant patient. Biopsies through the ulcer yielded cartilage with hyphae invading it. Fungal cultures of bronchial lavage grew Aspergillus fumigatus. He responded to oral itraconazole therapy.
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Patient had life threatening pneumonia, cavity formation was later observed. He later presented with a fungal ball. The aspergilloma was removed by surgical resection of the right upper lobe.
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