PMC4735106_01
Chest images and pathological findings of mucus plug from the patient. (A) X-ray image shows infiltration shadows (arrow) that moved in each period. (B) Computed tomography image shows proximal bronchiectasis (arrow) and mucus plug (arrowhead). (C) Hematoxylin-eosin staining shows Charcot-Leyden crystals (arrows) with clusters of eosinophils. (D). Periodic acid-Schiff's stain shows hyphae (arrowheads) indicating fungal infection.
gr1.jpg
PMC4735106_01_gr1.jpg
fig0005
A chest X-ray showed infiltrates in the right lower lung (Fig. 1A), and computed tomography revealed bilateral dilation of the central bronchi in the right upper lobe (Fig. 1B).
Aspergillus fumigatus and Schizophyllum commune isolated from mucus plug. (A) Morphologically characterized A. fumigatus. (B) Cultured S. commune isolate shows hyaline, septate hyphae with clamp connections and spicules (400x). (C) Granular to cottony, green-gray Aspergillus fumigatus colonies with apron at margin. (D) White, wooly colonies of S. commune isolated from sputum and inoculated onto SGA supplemented with benomyl after 4 days of incubation at 28  C. Slide (A and B) and SGA (C and D) cultures.
gr2.jpg
PMC4735106_01_gr2.jpg
fig0010
D). Direct microscopy of KOH wet mounts of three consecutive sputum specimens and expectorated sputum/mucoid plugs revealed two types of septate and branching hyphae (Fig. 2A and B). Homogenized sputum and mucoid plugs inoculated onto Sabouraud's glucose agar (SGA) developed green and white colonies with a wooly texture after 4 days at 2  C (Fig. 2C and D). One of the fungi was morphologically identified as A. fumigatus (Fig. 2A and C), but the other (Fig. 2B and D) remained obscure.