Case 111

1. Prepared by Abigayle Norwood and Reviewed by Sean Zhang MD PhD

An adult patient with a medical history of polycystic kidney disease status post kidney transplantation presented to the emergency department with cough, abdominal pain, and loose stools for approximately 2 weeks. Upon admission, they had a high fever (Tmax 102.6°F) and work up revealed pancytopenia and a positive Clostridioides difficile toxin B gene by nucleic acid testing. The patient's diarrhea improved with oral vancomycin. The cough was treated with loratadine.

The patient continued to spike intermittent fevers throughout their admission. They were started on broad-spectrum antimicrobials and a further infectious work up was initiated. Imaging studies revealed a lung nodule, hilar lymphadenopathy, and splenomegaly. Microbiology studies were significant for an elevated 1,3-beta-d-glucan and galactomannan. The fever ultimately improved and the patient was discharged on voriconazole with plans for outpatient follow-up of the lung nodule.

Two weeks later, a fungal culture of the patient's blood collected during hospitalization grew the filamentous organism pictured below. The microscopic features are most concerning for which of the following fungus?


11 thoughts on “Case 111”

  1. One thing I would like to say is that before acquiring more laptop memory, look into the machine into which it could be installed. If the machine can be running Windows XP, for instance, the actual memory limit is 3.25GB. The installation of greater than this would simply constitute any waste. Make sure that one’s motherboard can handle the particular upgrade quantity, as well. Interesting blog post.

  2. Nice read, I just passed this onto a friend who was doing some research on that. And he just bought me lunch because I found it for him smile Thus let me rephrase that: Thank you for lunch! “Procrastination is the thief of time.” by Edward Young.

Leave a Reply

Your email address will not be published. Required fields are marked *