PMC7069574_01
(A) A chest radiograph and (B) a computed tomography scan of the chest showing diffuse bilateral infiltrates.
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Chest radiography and computed tomography (CT) of the lung showed diffuse infiltrates bilaterally with no pleural effusion (Figure 1).
Chest radiographs obtained on day 3 (A) and 5 (B).
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ARDS (Figure 2A). A beta-D-glucan assay (beta-glucan test; FUJIFILM Wako Pure Chemical Corporation, Japan) on day 4 found it to be elevated at 37.6 pg/mL (normal range <11.0 pg/mL); serum galactomannan was not measured. The vasopressors could be stopped on day 5 but the hypoxia did not improve (Figure 2B).
Computed tomography scans obtained at autopsy show that the lungs were completely infiltrated by effusion.
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CT scans obtained at autopsy did not reveal any focal lesion in the brain; however, both lungs were completely infiltrated with effusion (Figure 3), were severely congested, and each weighed over 1000 g (Figure 4A).
(A) Both lungs were massively congested. (B) Numerous filamentous fungi are seen in the lung after Grocott staining (x400).
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CT scans obtained at autopsy did not reveal any focal lesion in the brain; however, both lungs were completely infiltrated with effusion (Figure 3), were severely congested, and each weighed over 1000 g (Figure 4A). Microscopic analysis with Grocott staining revealed diffuse filamentous fungi throughout the lungs within necrotizing tissue and intravascular lesions (Figure 4B), as well as in the heart, stomach, and thyroid gland.
(A) The right pulmonary artery contained an embolus (arrow). (B) Filamentous fungi (arrow) were detected in the embolus by Periodic acid-Schiff staining (x400).
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An embolus was detected in the right pulmonary artery (Figure 5A) but not in either femoral vein. The pulmonary embolus also contained filamentous fungi (Figure 5B), which might have been responsible for the patient's acute deterioration.