PMC9395215_01
(A) The blue arrow shows the left bronchial artery-the left pulmonary artery fistula; filling defects can be seen in image. (B) The red arrow shows the thickened bronchial artery (over 2mm). (A and B) Irregular patchy and nodular density was observed in both lungs.
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Filling defect was observed in the main pulmonary artery, bronchial artery diameter was widened, and irregular patchy and nodular density was observed in both lungs (Figure 1A and B). Fiber-optic bronchoscopy was performed, which revealed a large amount of purulent secretions, bronchoalveolar lavage fluid (BALF) fungi (1-3)-beta-d glucan: 728.06, and GM test: 3.239. CTPA and bronchial arterial angiography showed left bronchial artery-left pulmonary artery shunt (Figure 1A and B) and right bronchial artery-right pulmonary artery shunt.
(A and B) Pleomorphic fungi were observed by gram staining of BALF smear.
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Pleomorphic fungi were observed by gram staining of BALF smear (Figure 2A and B). Two consecutive BALF fungal cultures grew A. mycotoxinivorans (Figure 2A and B), the identity of which was confirmed by internal-transcribed-spacer (ITS) sequencing.
The white arrow shows that A. mycotoxinivorans were engulfed by leukocytes.
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The phagocytosis of A. mycotoxinivorans by leukocytes was observed under the microscope (Figure 3).