PMC5465417_01
Chest computed tomography scan taken 2 months before admission, showing consolidation of the right lower lung lobe with a high-density area.
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The patient had no symptoms at two months prior to her admission to our hospital; however, follow-up chest computed tomography (CT) without contrast showed new consolidation of the right lower lung lobe (Fig. 1).
Chest radiograph (A) and computed tomography scan (B) taken on hospitalization, showing enlargement of lung consolidation with a high-density area and bronchiectasis.
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Follow-up chest CT showed the enlargement of the patient's lung consolidation with a high-density area and bronchiectasis (Fig. 2).
Clinical course. BT: body temperature, CRP: C-reactive protein, div: intravenous drip, MCFG: micafungin, MEPM: meropenem, PIPC: piperacillin, po: per os, TAZ: tazobactam, VRCZ: voriconazole, WBC: white blood cell
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After increasing the patient's dose of meropenem to 3.0 g/day, her fever abated and the right hypochondralgia disappeared (Fig. 3).
(A) Light microscopic image of a bronchial lavage fluid culture, showing branching hyphae and conidia of Scedosporium prolificans (lactophenol cotton blue stain). (B) Magnified image of (A).
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Branching hyphae were detected in a bronchial lavage fluid culture, suggesting the possibility of a Scedosporium species (Fig. 4).
Chest computed tomography scan taken 3 months after initiation of voriconazole, showing decreased lung consolidation but a residual lesion.
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CRP level of 0.19 mg/dL, suggesting the improvement of inflammation. Chest CT showed the shrinkage of the consolidation in the right lower lung lobe; however, a residual lesion remained (Fig. 5).
Light microscopic images of a histopathologic specimen, showing a fungus-like substance in the bronchus. Inflammatory cell infiltration and collagen fiber hyperplasia is noted, but invasion of fungus-like substance into the lung tissue is not definitive. (A) Hematoxylin and Eosin staining. (B) Grocott methenamine silver stain.
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Inflammatory changes were revealed, and a fungus-like substance was detected in a Grocott methenamine silver-stained histopathological specimen from the bronchus (Fig. 6).