PMC7068122_01
Enhanced chest computed tomography (CT) images on the 21st day after admission. Pulmonary embolism of the left descending pulmonary artery was observed.. a. The arrow indicates the left anterior descending pulmonary artery and the arrowhead indicates the point where blood flow is interrupted by the embolus in the middle of the descending pulmonary artery. The separated arrow indicates a tuberculosis legion in the right upper lobe.. b. The arrow indicates a wide homogenous poor-contrast region of the left lower lobe. The arrowhead indicates the left descending pulmonary artery filled with the embolus.. c. Ground-glass opacity, which is one of the typical CT finding in invasive fungal infection, was not observed in the pulmonary window setting.
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Emboli were also detected in the left descending pulmonary artery (Fig. 1).
Macroscopic photograph of an axial slice of the left lung after formalin fixation. The arrow indicates a fungal mass filling the pulmonary artery.
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Gross pathology of a lung autopsy specimen revealed left lower pulmonary arterial embolism (Fig. 2) and pulmonary infarction (Fig. 3).
Enlarged images of a necrotic part of the lung.. a. Hematoxylin and eosin-stained section depicting bacteria.. b. Grocott-stained section depicting slightly positive staining of bacteria.. c. Immunostaining with anti-Mucor antibody*.. *Mouse anti-Rhizopus arrhizus (MCA2577; BioRad, New York, USA).
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Immunohistochemistry using a mouse anti-Rhizopus arrhizus antibody (clone WSSA-RA-1; BioRad, New York, USA) as the primary antibody revealed that the mold in the blood vessels of lung tissue was partially positive for the mucor antigen (Fig. 4).