PMC5588403_01
a Chest CT in December 2013 showed a 3 x 3 cm mass in the right middle lobe (arrows). b Chest CT in May 2014 revealed an emerging nodular lesion in the left lower lobe (arrows). c MRI showed bony destruction in L5 vertebral body (arrows). d MRI taken 1 month after the first lumbar surgery showed extensive bone lesions with paravertebral abscess at L2-L5 (arrows). e Specimens from the second lumbar surgery revealed a few spore or hyphae analogues. Periodic acid-Schiff. x200. f Specimens from the third lumbar surgery revealed septate hyphae of Aspergillus species. Gomori methenamine-silver. x200.
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C. Chest computed tomography (CT) showed a 3 x 3 cm mass in the right middle lobe along with multiple nodules in both lungs (fig. 1a). Chest CT scan indicated an emerging nodular lesion in the left lower lobe (fig. 1b), and magnetic resonance imaging (MRI) revealed bony destruction in the L5 vertebral body and L2/3 pedicle (fig. 1c). A new MRI showed deterioration of the imaging findings (fig. 1d). A few spore or hypha analogues were visualized in tissue sections with Gomori methenamine-silver stain and periodic acid-Schiff stain (fig. 1e). Notably, specimens from the third lumbar surgery primarily for spinal stabilization revealed septate fungal hyphae, dichotomously branching at acute angles (fig. 1f).