PMC7398192_01
a Plain CT chest showing bilateral diffuse miliary ground glass opacities. b MRI brain showing T2 hyperintense ring-enhancing lesion in the left superior parietal lobe suggestive of an abscess. c H&E x 40 Abscess wall with dense acute inflammatory exudates. d H&E x 400 showing multiple filamentous septate hyphae with acute angle branching. e H&E x 400 numerous fungal hyphae embedded in the exudates. f Silver methenamine stain x 400 demonstrating grey black colored fungal organisms. g PAS stain x 400 showing magenta colored organisms. h Sabourad dextrose agar demonstrating greenish blue colonies with white edges classical for A. fumigatus. Lactophenol cotton blue stained smear demonstrating fruiting bodies
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Fig1
She was diagnosed to have PAP on CT chest and bronchiole alveolar lavage (BAL) in another hospital 7 months earlier and was on treatment with corticosteroids (Fig. 1a). MRI brain showed a T2 hyperintense lesion in the left superior parietal lobe (Fig. 1b). Histopathology revealed a suppurative lesion with neutrophils and mononuclear cells (Fig. 1c). Amidst the necrotic material were seen delicate septate hyphae with acute angle branching (Fig. 1d-f). The hyphae were highlighted by Gomori methenamine silver (GMS) and periodic acid Schiff (PAS) stains (Fig. 1g). There were grey to blue green colonies and microscopy showed conidia (fruiting bodies) (Fig. 1h).