PMC4731902_01
Diagnostic imaging of Lomentospora prolificans endocarditis. a FDG-PET axial image showing abnormal linear uptake in the aortic root and the ascending aorta and b Transoesophageal echocardiogram (still shot) axial view demonstrating a large pedunculated mass within the ascending aorta arising from the commissure of the right and non-coronary cusp of the aortic valve with a calcified base; and cerebral emboli c MRI brain axial view, with some motion artefact, showing post-gadolinium enhancement of the right parasagittal frontal lobe consistent with an embolic lesion
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Fig1
There was no evidence of metastatic malignant disease detected, but an area of abnormal avidity was identified on the aortic valve (Fig. 1a). Transoesophageal echocardiogram (TOE) (Fig. 1b) revealed a pedunculated mass within the ascending aorta arising from the commissure of the right & non-coronary cusp of the aortic valve with a calcified base (20 x 14 x 11mm). Brain MRI identified a contrast-enhancing right parasagittal frontal lobe lesion consistent with an embolic lesion (Fig. 1c).
Direct Gram stain from the aerobic blood culture bottle at 72 h showing hyphae, conidiophores and conidia consistent with Lomentospora prolificans (400 x magnification)
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Fig2
On day 22 of admission, fungi were isolated from repeat blood cultures after 3 days of incubation using the automated BacT/ALERT 3D system (bioMerieux, USA) subsequently morphologically identified as Lomentospora prolificans (Fig. 2).