PMC3712737_01
Changes in the chest X-rays and chest computed tomography (CT) images of the patient. Chest X-rays and CT images at hospitalization and at 15, 18, and 27 days after hospitalization are shown.
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Consolidation of the upper lobes in the bilateral lungs was found in her chest X-ray and computed tomography image (Figure 1). C-reactive protein (CRP), which was 7.7 mg/dL on admission, gradually decreased to 2.2 mg/dL by 2 weeks following admission. Consolidation areas of the lungs also decreased (Figure 1). Pneumothorax occurred (Figure 1) and she needed mechanical ventilation.
Macroscopic examination of the lungs. Congestion and edema were observed in the lungs bilaterally - (A) left lung, (B) right lung. The upper lobe of the left lung showed hemorrhagic necrosis and a longitudinal fissure of approximately 9 cms long (arrows). The lower lobe of the left lung showed severe thickening of the pleura. Several cavities were observed in the middle lobe of the right lung and the inner wall of the cavities was yellow ochre in color and solid.
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Both lungs were found to show congestion and edema; the weights of the left and right lung were 550 g and 640 g, respectively (Figure 2).
Microscopic examination of the lungs. The hyphae of Zygomycota were frequently observed around and within the blood vessels causing obstruction and thromboembolization of blood vessels. Non-septated, irregularly branched hyphae of Zygomycota observed used a high power field are shown in (C and D). The specimens were stained with hematoxylin and eosin stain in (A and C), while those in (B and D) were stained with Grocott's methenamine silver stain.. Notes: Magnification: (A and B), x20; (C and D), x100.
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Non-septate irregularly branched hyphae of Zygomycota existed in the bilateral lungs and heart (Figures 3 and 4).
Microscopic examination of cavities in the middle lobe of the right lung and the heart. The hyphae of Aspergillus were observed in the wall of cavities in the middle lobe of the right lung (A and B). The hyphae show basophilic fungus bodies and Y-shaped branching. The hyphae of Zygomycota were observed around and within the blood vessels in the muscle layer of the left ventricle of the heart (C and D). In the blood vessels, thrombi were observed. Many inflammatory cells had infiltrated the blood vessels, suggesting that the Zygomycota infection induced vasculitis, thrombosis, and fungal myocarditis.. Notes: Magnification: (A), x10 (hematoxylin and eosin stain); (B), x100 (Grocott's methenamine silver stain); (C), x20 (Grocott's methenamine silver stain); (D), x60 (Grocott's methenamine silver stain).
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Non-septate irregularly branched hyphae of Zygomycota existed in the bilateral lungs and heart (Figures 3 and 4). In the wall of the cavity in the middle lobe of the right lung, there were numerous basophilic septate hyphae with Y-shaped branching, suggesting that these hyphae were Aspergillus (Figure 4A and B). Zygomycota hyphae were observed around and within the blood vessels in the muscle layer of the left ventricle of the heart (Figure 4C and D).