PMC9637885_01
Intraoperative photographs showing irrigation and debridement (ID) of sternal wound (left) and the open sinus following ID and removal of infected cartilage and sternum (right).
gr1.jpg
PMC9637885_01_gr1.jpg
fig0005
He underwent irrigation and debridement, inferior sternectomy, and removal of wires (Fig. 1).
Complete left costal cartilage "cast" displaying chronic destruction.
gr2.jpg
PMC9637885_01_gr2.jpg
fig0010
The left cartilage segments for ribs four through seven were removed in complete "casts" with evidence of cobblestoning and chronic destruction (Fig. 2).
Histopathology of removed costal cartilage displaying acute angle branching, narrow, septate hyphae of Aspergillus fumigatus (10x left and 50x right; Grocott-Gomori's methenamine silver stain).
gr3.jpg
PMC9637885_01_gr3.jpg
fig0015
Silver displayed acute-angle branching septate hyphae (Fig. 3). Susceptibility testing for Aspergillus was not available at the institution that this case took place, so voriconazole was chosen as empiric therapy.