PMC7215172_01
Non-contrast chest CT: (A) Appearance of fast-growing nodules in the right lung parenchyma at the end of the first course of chemotherapy with FLOT. (B) Control CT one week later. (C) Residual scarring lesions, after 4 months of antifungal treatment.
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Computed tomography was ordered in February 2019 showing diminution of lymph node size around 60 %, and appearance of new, rapidly growing lung nodules in the right middle and lower lobes (Fig. 1A-B). Treatment was started with itraconazole 200 mg QID for 4 months with an improvement of ESR (12 mm/h) and tomographic resolution of lung lesions (Fig. 1C).
Lung biopsy: (A) Chronic granulomatous inflammation with the presence of Langhans giant cells (arrowhead). H&E stain, 40 x . (B) Presence of budding yeasts compatible with Paracoccidioides spp. (arrows). Periodic acid-Schiff (PAS) stain, 100 x .
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Computed tomography-guided transthoracic needle biopsy of pulmonary nodules was performed and histopathology revealed a chronic granulomatous inflammatory infiltrate with Langhans giant cells and presence of multibudding yeast cell in periodic acid-Schiff (PAS) stain, compatible with Paracoccidioides sp. (Fig. 2).