PMC6501261_01
CT brain axial view demonstrating left frontal lobe mass concerning for glioblastoma.
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Due to his initial neurologic complaints, a brain computed tomography (CT) was completed (Figure 1), demonstrating a left frontal mass with surrounding cerebral edema and midline shift.
MRI brain axial view demonstrating multiple enhancing masses coalescing into a larger mass with surrounding edema resulting in midline shift involving anterior corpus callosum.
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Brain magnetic resonance imaging (MRI) (Figure 2) described the lesion as a conglomeration of multiple left frontal lobe enhancing masses causing midline shift.
CT chest demonstrating multifocal pneumonia in the left lung base with areas of suspected internal necrosis. No mediastinal lymphadenopathy is visible.
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CT of the chest (Figure 3) was performed for further characterization of the lung finding on CXR with the possibility of malignancy in question. It demonstrated a multifocal mass-like area of consolidation in the left lower lobe with necrosis and cavitation interpreted as a low suspicion for malignancy with close interval follow-up recommended (Figure 3).
Nocardia araoensis growing on cultures obtained from lung biopsy at 100x magnification stained with Kinyoun acid-fast stain.
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It was further speciated with matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS) and identified as Nocardia araoensis (Figure 4).
Cladophialophora bantiana showing septate hyphae with branching at 40x magnification from brain biopsy.
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Visual identification was made as Cladophialophora bantiana (Figures 5 and 6) after 20 days, referencing Larone's "Medically Important Fungi" text.
Cladophialophora bantiana growing on Sabouraud Agar from brain biopsy demonstrating velvety-textured olive-colored colonies.
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Visual identification was made as Cladophialophora bantiana (Figures 5 and 6) after 20 days, referencing Larone's "Medically Important Fungi" text.