Case of the Month
ANSWER TO Case of the Month
Patricia Benn M.D. MBA.
Andres Vasquez M.D, M.Sc.
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Figure 1.(A) AP Supine radiograph. (B-D) CT Pulmonary Window, axial, sagittal, and coronal reconstructions, respectively. Multiple thick-walled cavities of varying sizes, and areas containing a Tree-in-Bud pattern are present in both Upper and Lower Lobes. An intracavitary aspergilloma is seen in the anterior segment of the LUL (Circles). A large mucoid impaction (Arrow) with distal air-trapping (Asterisk) is present in the Lingula. Mucoid impactions are present in both Lower Lobes.
Figure 2. Due to the patient’s neurologic symptoms an MRI scan was performed. The heterogeneous lesion in the right Frontal lobe (Circle) was biopsied.
Figure 3. Brain biopsy specimen. (A) H&E stain, 100X. Septated hyphae at 45°angles (Circle) on necrotic background, compatible with Aspergillosis are present (B) Gomori Stain 100X. Septated, Gomori positive hyphae are seen. (C) PAS Stain 100X. Septated PAS positive hyphae are present.
Mainly seen in patients with prolonged neutropenia, transplant recipients, and patients with AIDS or chronic granulomatous disease. Cough, dyspnea and fever are common. Infection can extend to mediastinal and chest-wall structures. Hematogenous dissemination can involve virtually any organ, including the brain.
Invasive aspergillosis has been reported in 1 to 8% of liver transplant recipients.Infection typically occurs in the early post-transplant period.
- Segal BH. Aspergillosis. N Engl J Med 2009;360:1870-84.
- Franquet T, Müller NL, Giménez A, et al. Spectrum of pulmonary aspergillosis: Histologic, clinical, and radiologic findings. Radiographics. 2001; 21:825–837.
- Singh N and Paterson DL. Aspergillus infections in transplant recipients Clinical Microbiology Reviews. 2005; 18:44–69.
- Tempkin AD, Sobonya RE, Seeger JF, and Oh ES. Best cases from the AFIP. Cerebral aspergillosis: Radiologic and pathologic findings. RadioGraphics 2006; 26:1239–1242.