PMC3087438_01
Thoracic X-ray: (a) on day 176, it could be observed a small pulmonary node behind the fifth right thoracic rib (arrow); (b) 3 months, later the pulmonary node was much larger and became cavitated.
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On the thoracic X-ray (Figure 1(a)) there was small pulmonary node that gradually enlarged so he forwarded a thoracic CT, on day 192 which revealed a cavitated lesion on the right superior pulmonary lobe. However, he maintained persistent fever and the pulmonary cavitated nodule continued to get worse on thoracic X-ray image (Figure 1(b)).
CT scan of the perinasal sinuses: infiltrative lesion of the perinasal sinuses that exerts compression on the right optic nerve.
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CT scan of the perinasal sinuses revealed an infiltrative lesion of the perinasal sinuses with ethmoiditis and compression of the right optic nerve (Figure 2).
Ethmoiditis due to Scedosporium apiospermum. (a) Mucosa lined by respiratory type epithelium with intense inflammatory reaction (hematoxylin and eosin [H&E] staining, magnification x100); (b) higher magnification (x400) of (a) it can be identified numerous epithelioid granulomas and multinucleated giant cells; (c) partially destroyed bone tissue and numerous fungal hyphae (H&E staining, magnification x100); (d) morphologically the fungal hyphae resemble Aspergillus spp. (H&E, magnification x400); (e) bone tissue destruction by fungal hyphae (PAS staining, magnification x100); (f) the main host response is a mixed neutrophilic and monocytic infiltrate (PAS staining, magnification x400).
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Pathology analysis showed signs of ethmoiditis and numerous fungal hyphae (Figures 3(a)-3(f)).