PMC7303448_01
Chest CT findings before treatment. An examination of the carina (upper) and lower lobe (bottom) revealed bronchial wall thickening with para-bronchi infiltration in almost all large bronchi. CT: computed tomography
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Chest computed tomography (CT) revealed multiple regions of bronchial wall thickening with peribronchial infiltrations before treatment (Fig. 1).
Findings of fiberoptic bronchoscopy and histopathological examination of transbronchial lung biopsy (TBLB) specimens. A) An examination of the mucosa from the trachea to the bilateral distal bronchi showed ulceration and swelling with geographical moss-like white coats. B) A TBLB specimen stained with Hematoxylin and Eosin staining showed the presence of extensive fungal hyphae and lung parenchymal regions with inflammation. Hyphal invasion into the lung parenchyma and surrounding blood vessels from the right B4 lung segment was not observed (x200). C) Grocott-stained specimens of the lung tissues (x400).
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Fiberoptic bronchoscopy showed multiple areas of ulceration and swelling, with geographical, moss-like white coats on the tracheobronchial mucosa (Fig. 2A). Each TBLB specimen stained with hematoxylin and eosin showed similar findings of the presence of extensive fungal hyphae, although the presence of hyphal invasion into the lung parenchyma and surrounding blood vessels could not be verified (Fig. 2B). Grocott staining revealed multiple septate hyphae, branched at acute angles, and the hyphae were grouped in typical Aspergillus conidial heads (Fig. 2C).
Chest CT findings 14 days after initiation of anti-fungal treatment. Findings of the carina (upper) and lower lobe (bottom) revealed cylindrical bronchiectatic changes in almost all large bronchi. CT: computed tomography
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Chest CT 14 days after treatment initiation revealed cylindrical bronchiectatic changes with peribronchial infiltration (Fig. 3).