PMC4531665_01
Chest radiograph shows bilateral variable-sized multifocal consolidation with reticulonodular opacities. Note a cavitary lesion in the left lower lung zone.
kjim-17-2-138-9f1.jpg
PMC4531665_01_kjim-17-2-138-9f1.jpg
f1-kjim-17-2-138-9
Chest radiography and high-resolution computed tomography (HRCT) showed multifocal variable-sized consolidation with reticulonodular opacities (Figure 1) and cavitary lesion in both upper lobes and right lower lobe.
(A) High-resolution computed tomography shows multifocal variable-sized consolidation. (B) Cavitary lesions in both upper and right lower lobes formed by expectoration of mucus from ectatic bronchi. There were multiple small nodular densities and ground glass attenuation around consolidation.
kjim-17-2-138-9f2.jpg
PMC4531665_01_kjim-17-2-138-9f2.jpg
f2-kjim-17-2-138-9
There were also multiple small nodular densities and ground glass attenuation around the consolidation (Figure 2A, B).
Histological findings of chronic necrotizing pulmonary aspergillosis. (A) Focus of necrotizing pneumonia with an infarct-like appearance (H&E, x200). (B) Gomori-Methenamine Silver stain showing scattered fragments of fungal hyphae characteristic of aspergillus species (GMS, x200).
kjim-17-2-138-9f3.jpg
PMC4531665_01_kjim-17-2-138-9f3.jpg
f3-kjim-17-2-138-9
Histopathologic findings of the biopsy specimen showed large areas of necrotizing pneumonia with an infarct-like appearance (Figure 3A). There were some scattered fungal hyphae within the lung parenchyma (Figure 3B).
Histologic section of the lung reveals a bronchocentric granulomatous-like appearance with a necrotizing granulomatous bronchiolitis with luminal necrotic debris and replacement by a palisaded histiocytic reaction (H&E, x200).
kjim-17-2-138-9f4.jpg
PMC4531665_01_kjim-17-2-138-9f4.jpg
f4-kjim-17-2-138-9
Some terminal bronchioles were found to be destroyed and were replaced by granulomatous inflammation (Figure 4).
Histologic examination of bronchial casts reveals fibrinoid necrotic material mixed with neutrophils and aspergillus fungal hyphae (H&E, x400).
kjim-17-2-138-9f5.jpg
PMC4531665_01_kjim-17-2-138-9f5.jpg
f5-kjim-17-2-138-9
Histopathologic examination of the casts revealed fibrinoid necrotic tissue containing neutrophils, a few metaplastic squamous cell nests and variably fragmented fungal hyphae (Figure 5).