PMC4937763_01
Bilateral symmetrical peribronchovascular infiltration in both upper lobes and superior segment of lower lobe.
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F1
High resolution computed tomography scan (HRCT) of the lungs was performed and revealed bilateral symmetrical peribronchovascular infiltration in both upper lobes and superior segment of lower lobes in favor of P. jiroveci (Figure 1).
(A,B). Slide culture of P. notatum stained with lactophenol blue.
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F2
Penicillium notatum was identified based on slide culture morphology and colony shape (Figure 2 A,B).
The results of histological examination of the lung specimen Showed inflammatory cells, fibrin deposition and reactive pneumocytes (3A) and intra alveolar eosinophilic material (3B).
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F3
On the other hand, TBLB (methylene blue staining of lung section) revealed severe interstitial inflammatory cells, fibrin deposition and reactive pneumocytes (Figure 3A) and intra alveolar eosinophilic material (Figure 3B) suggestive of P. jiroveci; accordingly, primaquine and clindamycin were continued for 14 days.