PMC9344346_01
Swollen and discharging lesions on the right foot of the patient at first visit.
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This was followed by a gradually progressing foot swelling, and after 6 months, secretory sinuses opened to the dorsal and lateral surfaces of the foot discharging purulent fluid (Fig. 1).
Lateral sagittal contrast-enhanced T1 FS and axial TIRM T2 FS images of the ankle shows the abscess's disappearance around the calcaneus and the ankle.
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A technetium-99 m bone scan was suggestive of active infection of the left distal tibial head (osteomyelitis) as evidence by an increased flow (in angiographic phase) and mild hyperactivity (in delayed phase) at the left distal head of tibia bone (Fig. 2).
Microscopic examination of biopsy sample stained by hematoxylin and eosin (H&E) demonstrating septate hyphae (a), macroscopic appearance of the isolate on sabouraud dextrose agar compatible with Aspergillus spp. (b), and microscopic features of the isolate (400x) compatible with A. flavus (c).
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Microscopic examination of tissue sections revealed hyaline septate hyphae upon direct microscopy (Fig. 3a). After five days of incubation, white, mold- colonies were seen at inoculation sites, which slowly became yellowish and finally light green (Fig. 3b); the fungus was identified as a member of the genus Aspergillus owing to macroscopic and microscopic features such as hyaline, septate hyphae with a few spherical conidia released from phialide cells (Fig. 3c).
Improved lesions of the patient in one year follow.
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Treatment was continued for two months (in total four months) and in one year follow up, the lesions were healed and the patient was in a healthy status (Fig. 4).