PMC5203892_01
Sequential MRI images of the patient. (a) MRI before the initiation of anti-Koch's therapy. (b) MRI image after 4 months of anti-Koch's therapy. (c) MRI image after 9 months of anti-Koch's therapy. (d) MRI image after 12 months of anti-Koch's therapy.
CRIOR2016-8705204.001.jpg
PMC5203892_01_CRIOR2016-8705204.001.jpg
fig1
Imaging) images starting with the first one taken 14 months ago (Figure 1(a)). It showed spondylodiscitis at lumbar 4 and lumbar 5 region and patient was started on anti-Koch's therapy. The lesion rather progressed in the second MRI (Figure 1(b)). The third MRI taken 9 months after anti-Koch's therapy treatment did not even show any improvement (Figure 1(c)). The fourth MRI was taken after the patient completed 1 year of anti-Koch's therapy (Figure 1(d)).
CT scan of the chest showing lesion in the lungs. Biopsy of these lesions was inconclusive.
CRIOR2016-8705204.002.jpg
PMC5203892_01_CRIOR2016-8705204.002.jpg
fig2
It showed lesions in the lung and liver (Figure 2).
Microscopic image (Silver Methenamine, Haemotoxylin and Eosin Staining) of the 4th pedicle biopsy showing hyphae and yeast-like cells suggesting Pheohyphomycosis. The biopsy material was stained with Silver Methenamine with H&E counterstaining. Gram-positive hyphae/pseudohyphae can be appreciated.
CRIOR2016-8705204.003.jpg
PMC5203892_01_CRIOR2016-8705204.003.jpg
fig3
The microscopy showed hyphae and yeast-like cells representing Pheohyphomycosis (Figure 3).
Radiographic evidence of improvement in spine and chest after antifungal treatment. (a) and (b) represent anteroposterior X-rays of lumbar spine, before and after treatment, respectively. (c) and (d) represent lateral X-rays of lumbar spine, before and after treatment, respectively. (e), (f), and (g) represent the sequential improvement in chest radiographs after the initiation of antifungal treatment.
CRIOR2016-8705204.004.jpg
PMC5203892_01_CRIOR2016-8705204.004.jpg
fig4
The improvements in the radiographs of chest and spine were also evident (Figure 4).