PMC5724640_01
(a) Chest X-ray obtained on the second day of admission showed right thyroid gland enlargement with tracheal impingement, disseminated miliary shadows, and an enlarged heart. (b) Chest X-ray obtained on the sixth day of admission showed bilateral infiltration with disseminated miliary shadows as well as enlarged hilar lymph nodes. (c) Chest X-ray obtained on the 18th day of antifungal administration showed disseminated miliary shadows and an enlarged heart with absence of bilateral infiltration.
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Chest X-ray showed disseminated miliary shadows (Figure 1(a)). Chest X-ray examination, performed on the sixth hospital day, showed bilateral infiltration with disseminated miliary shadows and enlarged hilar lymph nodes (Figure 1(b)). It was observed that the patient showed significant clinical improvement (Figure 1(c)).
(a) The fungus grew on Sabouraud's dextrose agar medium incubated at 25 C for 10 days. The mold form of fungus with mycelia was observed. Soluble red pigment was diffused into the medium. (b) The fungus grew on Brain Heart Infusion Agar incubated at 37 C for 6 days. The yeast form of fungus was observed. (c) Microscopic appearance after lacto phenol cotton blue staining. Mycelial morphology was obtained after a 10-day incubation on Sabouraud's dextrose agar medium at 25 C. It showed hyaline, septate, branched hyphae with branched conidiophores or penicilli. (d) Microscopic appearance after lacto phenol cotton blue staining. The yeast-like appearance was observed after inoculation on Brain Heart Infusion Agar and incubated at 37 C for 24 h.
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Notably, the medium became red-brown in color since the soluble red pigment diffused into the medium (Figure 2(a)). Microscopic examination showed the mycelia morphology as hyaline, septate-branched hyphae, with branched conidiophores (Figure 2(c)). At 37 C temperature, the yeast form grew on the brain heart infusion agar (Figure 2(b)) and the microscopic examination showed yeast-like appearance of the fungus (Figure 2(d)).