Date: 26 November 2013
X-Rays -Allergic Bronchopulmonary Aspergillosis (ABPA) with 3 relapses.
A female patient JO (50 yrs) with right middle lobe collapse. The patient presented with a 6 month history of cough which has persisted despite antibiotics and both steroid and salbutamol inhalers. She then developed acute breathlessness with coughing and wheezing. There was no history of asthma. Bronchoscopy (Image K) showed a mucous plug obstructing the right upper lobe bronchus.
Images D – G are X rays showing relapse in 1998 and recovery
Images H – J are X rays showing relapse in 2003
Image K. Bronchoscopy appearance of mucous impaction of the bronchus intermedius – pt JO (50yrs). There was a long mucous plug in the anterior segment of the RUL. Half of this was aspirated and sent for microscopy and culture. The second half “fell into” the bronchus intermedius (which feeds the right middle lobe) and was only partially aspirated.
Images L – O: High resolution CT scan of thorax in pt JO, post bronchoscopy. 1.5mm sections at 1 cm intervals of whole lung. There is collapse and consolidation in the right middle lobe with dilation of the right middle lobe bronchi. There is also minor bronchiectasis in the right upperlobe with a little patchy air space shadowing . There is no mediastinal lymphadenopathy or any interstitial fibrosis.
Image P & Q: Histology: Mucous plug (3x 0.5x 0.5cm) containing numerous inflammatory cells, including eosinophils and nuclear debris.GMS staining reveals occasional fungal hyphae with septa and dichotomous branching. These appearances support the diagnosis of bronchopulmonary Aspergillosis. Bronchioalveolar lavage fluid was negative on microscopy and no fungi were grown. A year later Aspergillus fumigatus was grown from her sputum.
Copyright: n/a
Notes: n/a
Images library
-
Title
Legend
-
BAL specimen showing hyaline, septate hyphae consistent with Aspergillus, stained with Blankophor
-
Mucous plug examined by light microscopy with KOH, showing a network of hyaline branching hyphae typical of Aspergillus, from a patient with ABPA.
-
Corneal scraping stained with lactophenol cotton blue showing beaded septate hyphae not typical of either Fusarium spp or Aspergillus spp, being more consistent with a dematiceous (ie brown coloured) fungus
-
Corneal scrape with lactophenol cotton blue shows separate hyphae with Fusarium spp or Aspergillus spp.
-
A filamentous fungus in the CSF of a patient with meningitis that grew Candida albicans in culture subsequently.
-
Transmission electron micrograph of a C. neoformans cell seen in CSF in an AIDS patients with remarkably little capsule present. These cells may be mistaken for lymphocytes.
-
India ink preparation of CSF showing multiple yeasts with large capsules, and narrow buds to smaller daughter cells, typical of C. neoformans
 and relapses){kind=link}