PMC7537625_01
Gross findings in brain and lungs: A and B, multiple hemorrhagic foci and abscesses in brain (A) and midbrain (B); C, Diffuse tan-yellow exudate on pleural surface of bilateral lungs; D, Rubbery texture and edema in lung parenchyma with interlobular septa covered with tan-yellow exudates.
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Internal exam showed multiple hemorrhagic foci and abscesses involving the cerebral hemispheres from the frontal lobes to occipital lobes, basal ganglia, midbrain, brainstem, and right cerebellum (Fig. 1. There were 200 mL of red-tan fluid in the left pleural cavity and the pleural surfaces were covered by tan-yellow exudates (Fig. 1. The pulmonary parenchyma was dark red-purple with increased edema and a rubbery texture and the interlobular septa were covered with tan-yellow exudates (Fig. 1.
Fungal culture of brain tissue in inhibitory mold agar grew brown-purple velvety colonies on surface (A), with light gray discoloration on reverse side (B). The fungus was identified as M. gracilis.. Please note: Color should be used for all figures in print
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The fungi presented as branching septate hyphae that were confirmed by Chromic Acid-Schiff-diastase (CAS-F-D) special staining (Fig. 2); occasionally, conidiogenous cells on branching aerial hyphae and short chain of conidia were found amongst the necrotic material. Similar appearing fungal organisms along with hemorrhage, neutrophilic inflammation, and necrosis were identified in heart, and pleura (Fig. 2), with rare fungal elements in the peripheral parenchyma of lungs.
Histologic findings of invasive fungi infections in multiple organs and tissue: Similar appearing fungal organisms with branching septate hyphae and conidiogenous cells as well as single or short chains of conidia, along with hemorrhage, neutrophilic inflammation, and necrosis in the pleura (A, HE, 200x), heart (B, HE, 200x), and brain (C, HE, 400x; D, CAS-F-D stain, 400x). Arrows are pointing to hyphae in the tissue. HE: hematoxylin and eosin stain; CAS-F-D: Chromic Acid-Schiff-diastase.
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Portions of the brain tissue were submitted for fungal culture which showed growth of M. gracilis. (Fig. 3). Fungal culture of brain tissue on inhibitory mold agar incubated at both 27  C and 37  C yielded dark brown, velvety mold colonies with mostly brown mycelia (Fig. 3).