Date: 26 November 2013
The chest x-ray shows a patient who had a left lung transplanted in May 2003 for cryptogenic fibrosing alveolitis, which was diagnosed post-transplant as sarcoidosis.
Copyright: n/a
Notes:
The donor was CMV negative, the recipient CMV positive and the ischaemic time of the transplanted lung was 5 hours. Bronchoscopy a week post-transplant revealed no evidence of airway narrowing. However, he developed an area of necrotic tissue and sputum plugging partially obstructed the left main bronchus over the next couple of month’s which were managed bronchoscopically without evidence of infection. There was also some evidence of narrowing of the airways, which required insertion of a bronchial stent three months post transplant. Three months following this, the stent was in a good position but there was a considerable amount of mucus and pus around the stent, which was removed bronchoscopically. This grew Aspergillus fumigatus. He was treated with itraconazole with the stent remaining in situ.
Images library
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BAL specimen showing hyaline, septate hyphae consistent with Aspergillus, stained with Blankophor
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Mucous plug examined by light microscopy with KOH, showing a network of hyaline branching hyphae typical of Aspergillus, from a patient with ABPA.
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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
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Corneal scrape with lactophenol cotton blue shows separate hyphae with Fusarium spp or Aspergillus spp.
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A filamentous fungus in the CSF of a patient with meningitis that grew Candida albicans in culture subsequently.
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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.
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India ink preparation of CSF showing multiple yeasts with large capsules, and narrow buds to smaller daughter cells, typical of C. neoformans
