Date: 26 November 2013
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.
Copyright: n/a
Notes:
This patient was reported in Kramer MR, Denning DW, Marshall SE, Ross D, Berry G, Lewiston N, Stevens DA, Theodore J. Ulcerative tracheobronchitis following lung transplantation: a new form of invasive aspergillosis. Am Rev Resp Dis 1991; 144: 552-556.
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The chest x-ray shows a patient who had a left lung transplanted in May 2003 for cryptogenic fibrosing alveolitis, which was diagnosed post-transplant as sarcoidosis.
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Gross pathology demonstrating the great pleural thickness and two cavities (upper lobe and superior segment of lower lobe) with fragments of fungal mass.
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Histopathological appearance of a fungus ball. Note a conidial head resulting from fungal exposure to the air.
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Histopathological appearance of a fungus ball caused by Scedosporium apiospermum. The presence of anneloconidia differentiates it from Aspergillus.
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Chronic necrotising aspergillosis. Hyaline hyphal and calcium oxalate crystals obtained by needle aspirate biopsy from a diabetic patient with chronic necrotizing aspergillosis caused by Aspergillus niger (Papanicolaou, x 100).
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Aspergillus niger fungus ball and acute oxalosis. Higher magnification of adjacent replicate section.
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Oxalate crystals within renal tubuli (H&E, phase contrast, x 100). This patient developed acute oxalosis.
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Lung surface. Fungus ball, severe parenchymal fibrosis and pleural thickening.
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