PMC6304639_01
Axial contrast enhanced T1 WI brain MRI demonstrating rim enhancing lesions in the right peritrigonal white matter and left corona radiata.
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MRI brain illustrated rim-enhancing lesions with diffusion restriction in the right peritrigonal and left corona radiata (Figure 1) while orbital sections showed circumferential smooth enhancement in the left globe and optic nerve sheath (Figures 2 and 3).
Axial T2 weighted image through the left orbit demonstrating irregular thickening of the posterior and medial wall of the left globe.
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MRI brain illustrated rim-enhancing lesions with diffusion restriction in the right peritrigonal and left corona radiata (Figure 1) while orbital sections showed circumferential smooth enhancement in the left globe and optic nerve sheath (Figures 2 and 3).
Axial contrast enhanced T1 WI through the left orbit demonstrating periorbital soft tissue swelling and enhancement (1) and smooth circumferential enhancement of sclera (2) and choroid (3); enhancement of the left optic nerve sheath and retrobulbar fat (4).
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MRI brain illustrated rim-enhancing lesions with diffusion restriction in the right peritrigonal and left corona radiata (Figure 1) while orbital sections showed circumferential smooth enhancement in the left globe and optic nerve sheath (Figures 2 and 3).
(a) PAS stain of the retinochoroidal biopsy demonstrates septate filamentous fungi with acute angle branching consistent with Aspergillus fumigatus. (b) Pap stain of the vitreous fluid shows acute inflammation, fibrin, and true septate hyphae with 45-degree branching. (c) Hematoxylin and eosin-stained squash preparation from the brain lesion demonstrates true hyphae with 45-degree branching in a background of necrotic debris.
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Septate filamentous fungi with acute angle branching characteristic of Aspergillus fumigatus were noted on retinochoroidal biopsy (Figure 4(a)). Two weeks later, culture from the initial vitrectomy demonstrated Aspergillus fumigatus (Figure 4(b)). Pathology from the brain tissue that was biopsied by neurosurgery demonstrated organisms morphologically consistent with Aspergillus as well (Figure 4(c)).