PMC5337471_01
CT scan of the chest. (A, B) on day 180 from transplantation. (C, D) on day 204 from transplantation.
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Thoracic CT scans showed nodule growth in the right upper lobe, consolidation of the right inferior lobe, pleural effusion, and pericardial effusion (Fig. 1A and B). After 24 days of the antifungal therapy, a follow-up thoracic CT scan showed resolution of the pulmonary nodules, consolidation, pleural effusion, and pericardial effusion (Fig. 1C and D), and the sputum culture was negative for C. bertholletiae.
(A)Trichoderma longibrachiatum shows septate hypha. (B)Cunninghamella bertholletiae shows aseptate hypha with gram stain. Magnificationx1,000. (C) Culture of the bronchoaspiration samples on chocolate agar.
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A direct microscopic examination of sputum, bronchoaspiration, and bronchoalveolar lavage fluid samples revealed the presence of fungal septate and aseptate hyphae (Fig. 2A and B). Fungal growth occurred within two days on Sabouraud dextrose agar and chocolate agar at 30 C and 37 C, respectively (Fig. 2C).
Clinical course of infection: relationship of fever (solid line), CRP (dot), neutrophil count (white dot) and L-AmB administration.
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After 3 days of L-AmB administration, his fever declined, and 5 days thereafter, the sputum culture was negative for T. longibrachiatum, but positive for C. bertholletiae (Fig. 3).