Ewha Med J.  2016 Apr;39(2):65-68. 10.12771/emj.2016.39.2.65.

Invasive Pulmonary Aspergillosis Histologically Mimicking Mucormycosis

Affiliations
  • 1Department of Internal Medicine, KEPCO Medical Center, Seoul, Korea.
  • 2Department of Pathology, KEPCO Medical Center, Seoul, Korea.
  • 3Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea. humanmd04@hanmail.net

Abstract

Differential diagnosis of invasive aspergillosis from other pulmonary fungal infections including mucormycosis is important because the treatment is pathogen-dependent. Clinically, invasive aspergillosis is often discriminated from other mold infections on the basis of typical histopathologic features in the biopsy specimen. However, biopsy alone is not always complete because different fungal species can display similar histopathologic features. Surrogate markers or molecular-based assays can be useful when the results of conventional diagnostic modalities are conflicting. Here, we present a case of invasive pulmonary aspergillosis histologically mimicking mucormycosis, which was confirmed by fungal polymerase chain reaction.

Keyword

Aspergillosis; Galactomannan; Mucormycosis; Polymerase chain reaction

MeSH Terms

Aspergillosis
Biomarkers
Biopsy
Diagnosis, Differential
Fungi
Invasive Pulmonary Aspergillosis*
Lung Diseases, Fungal
Mucormycosis*
Polymerase Chain Reaction

Figure

  • Fig. 1 Chest imaging at presentation. (A) Chest X-ray shows a 4 cm-sized cavitary lesion at right upper lobe. (B) Chest computed tomography scan reveals a thick, irregular-walled cavity at right upper lobe.

  • Fig. 2 Histopathologic image. In the biopsy specimen, non-septated and broad hyphae (arrows) with infiltration of inflammatory cells are detected. The finding is suspicious of mucormycosis (H&E, ×200).

  • Fig. 3 Polymerase chain reaction results using β-tubulin gene. Internal transcribed space and β-tubulin genes were used to identify isolate to the species complex level and to the species level within the complex, respectively. The sequences derived from those two genes were compared with sequences available in GenBank. The results confirmed that the isolate is 100% identical to Aspergillus fulmigatus.

  • Fig. 4 Chest computed tomography scan after treatment with voriconazole. After 2 months of treatment, the lesion is markedly shrunken with remnant small consolidation.


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