PMC7350128_01
A: Initial CT scan. B: Histology.. Microscopic examination shows interstitial organization with proliferation of spindled fibroblasts in a loose matrix forming polypoid shapes, known as Masson body, which is highlighted by Movat stain. Interstitial mild chronic inflammation is also noted. There is also evidence of emphysematous changes. AFB and GMS stains shows no obvious acid fast and fungal organisms respectively on histology slides. No significant birefringent crystals are identified on polarized microscopy. Immunohistochemical stains S-100 and CD1a are negative, ruling out Pulmonary Langerhans Cell Histiocytosis. C: Paecliomyces formosus under the microscope
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Chest x-ray showed mild interstitial prominence and CT chest showed multiple subpleural nodular opacifications involving all lobes bilateral (Fig. 1A). Tissue samples cultured showed growth of Paecilomyces species in all three wedge biopsies and pathology consistent with organizing pneumonia and emphysematous changes (Fig. 1 B).