PMC4472550_01
A) In the initial chest CT, a 'halo sign' and 'air crescent sign' are visible. B) CT during hospitalization. C) CT after 2 months of treatment. D) CT after 11 months of treatment
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A computed tomography (CT) of the chest revealing an air crescent sign (Fig. 1 A) is highly suggestive of infection by an angioinvasive fungus, most commonly Aspergillus. On the 25th day of hospitalisation, a repeat CT scan revealed that the oval nodules were smaller and the cavity had essentially disappeared (Fig. 1 B); moreover, his maxillofacial ulcers had become encrusted and the soft tissue swelling had subsided. Two months later, a follow-up CT scan showed that the oval nodules were much smaller than in previous images (Fig. 1 C). At the time of writing, the patient's temperature was almost normal, and a CT scan showed that the oval nodules had almost completely disappeared (Fig. 1 D).
A) Inflammation of the bilateral ethmoid sinus and B) maxillary sinus. C) Thickening of soft tissue on the left side of the ala nasi in the paranasal sinus CT. D) Maxillofacial soft tissue swelling
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The patient was conscious with no enlargement of superficial lymph nodes, maxillary sinus tenderness, or maxillofacial soft tissue swelling due to inflammation (Fig. 2).
Microscopic examination of Aspergillus fumigatus (A, 10x magnification), and microscopic examination revealing conidial heads (B, 40x magnification)
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The conidia were nearly spherical and appeared similar to a chrysanthemum (Fig. 3).