PMC9755516_01
(A) Microscopic image of a skin lesion. Histologic examination of a skin biopsy following periodic acid-Schiff (PAS) staining shows the extravasation of hyphae from a blood vessel into the surrounding tissue. It is important to note that there is not any reaction of the cellular immune system against this fungal invasion. (B) Tissue biopsy of the cutaneous lesion showing vascular invasion and infarction by small, septated hyphae intermingled with chlamydoconidiae (indicated by the arrows) stained by Grocott's methenamine silver stain (magnification 10x), both day +17. Both images were obtained from the same FFPE (formalin-fixed paraffin embedded) tissue.
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F1
Histopathology after Grocott's methenamine silver (GMS) stain showed vascular invasion and infarction by strongly stained small, septated hyphae with acute angle branching and small, single-celled chlamydoconidiae (Figures 1A,B).
Macroscopic and microscopic image of the ruptured spleen. (A) Macroscopic image of the spleen. Solid arrows indicate multiple intravascular fungal lesions with perifocal bleeding. Asterisk shows the red pulp with dark brown discoloration consistent with transfusion associated hemosiderosis. Circle shows the splenic hilum with the lienal vein (hash sign), where fungal lesions outside the spleen can be identified (open arrow). (B,C) Microscopic images of a splenic lesion following periodic acid-Schiff (PAS). (B) and Grocott's silver staining (C) showing hyphae and chlamydoconidiae of Fusarium solani. The length of the lower border is 612 microm each.
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F2
Diffuse involvement of the spleen with mold species was confirmed upon pathological examination (Figures 2A-C).
(A and B) Views on thrombus (white arrows) in the outflow tract of the left ventricle, day +80.
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F3
In transesophageal echocardiography (TEE), a floating thrombus in the outflow tract of the left ventricle with a size of 1.5 cm was found (Figures 3A,B).
Synopsis of the clinical course and treatment. HSCT, hematopoietic stem cell transplantation; ATG, antithymocyte globulin; CSA, ciclosporin A; CMV, cytomegalovirus.
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F4
The timeline of major events is provided in Figure 4.