PMC9615570_01
(A) Chest computed tomography (CT) scan with multifocal bilateral mixed ground-glass opacity and consolidation, including central and peripheral distribution, and bilateral pleural effusion. (B, C) Swelling of the right eye and deep necrotic ulcer in the palate. (D, E) Paranasal and orbital CT scan demonstrated opacification and air-fluid level in the bilateral sphenoid and ethmoid sinuses and the right maxilla along with mucosal thickening in the left maxilla and fat haziness in the right extraconal and intraconal locations.
fcimb-12-898477-g001.jpg
PMC9615570_01_fcimb-12-898477-g001.jpg
f1
A computed tomography (CT) scan of the chest demonstrated multifocal bilateral mixed ground-glass opacity and consolidation, including central and peripheral distribution, and bilateral pleural effusion ( Figure 1A ). After 7 days of hospitalization, the patient developed right-side periorbital edema, proptosis of the right globe, necrosis of the hard palate, and nasal bleeding ( Figures 1B, C ). A paranasal and orbital CT scan demonstrated opacification and an air-fluid level in the bilateral sphenoid and ethmoid sinuses and the right maxilla along with mucosal thickening in the left maxilla and fat haziness in the right extra- and intraconal locations ( Figures 1D, E ).
(A) Direct microscopic examination using 10% potassium hydroxide revealed broad, aseptate hyaline hyphae with wide-angle branching. (B) Histopathologic examination with hematoxylin and eosin stain showing abundance in granulation tissue with foreign-body reaction and broad, aseptate hyphae in the intravascular space with wide-angle branching.
fcimb-12-898477-g002.jpg
PMC9615570_01_fcimb-12-898477-g002.jpg
f2
Samples from wounds, tissue necrosis, and bloody secretions of the eye were taken and subjected to direct examination by microscopy using a potassium hydroxide preparation ( Figure 2A ), fungal culture, and histopathology ( Figure 2B ).
(A, B) Morphological characteristics of colonies on Sabouraud dextrose agar on the surface and the reverse after 4 days of incubation at 25 C. (C) Microscopic appearance of the isolate as observed on a slide prepared from the fungal culture.
fcimb-12-898477-g003.jpg
PMC9615570_01_fcimb-12-898477-g003.jpg
f3
The colony surface was white when young, becoming cream-to-yellow or brownish-gray later on ( Figure 3A ). The reverse was white-to-pale yellow ( Figure 3B ). Moreover, disintegration might have left a small collar at the foundation of the columella, and the sporangiospores were smooth and generally elongated and may have appeared as pale brown in mass ( Figure 3C ).