PMC5436917_01
A - Gross specimen of the heart showing the grey-white area in the region of the interventricular septum and the right ventricular wall; B - Gross specimen of the lung showing multiple friable grey-white necrotic areas on the cut section.
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On cut section, multiple gray-yellow plaques were seen in the left ventricular wall, the interventricular septum, and the apex regions (Figure 1A). The cut surface of both lungs showed multiple gray-white necrotic areas (Figure 1B).
Gross examination of the kidney. A - Multiple nodular and cavitary lesions on the external surface; B - A cystic lesion on the cut surface.
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The kidneys weighed 150 g (right kidney) and 130 g (left kidney) and measured 10 x 5 x 2 cm and 9 x 5 x 2 cm; the cut surface showed grey-yellow necrotic areas (Figure 2).
Photomicrophotographs of the heart, which reveal the destruction of cardiomyocytes intermingled with necrotic debris and fungal hyphae (A - H&E, 40X). The fungal hyphae were septate with acute angle branching, PAS positive (B - PAS, 100X & C - PAS, 400X) and GMS positive (D - GMS, 100X).
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Periodic acid-Schiff (PAS) and Gomori methenamine silver (GMS) stain of the fungus demonstrated the distinct dichotomous acute angle branching of septate hyphae with the orientation of the branches in a similar direction (Figure 3).
Photomicrophotographs of the lung (A - H&E, 100X) and kidney (B - PAS, 400X) revealing the presence of similar fungal hyphae.
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These fungal hyphae were again demonstrated with the help of PAS and GMS stains (Figure 4).