Case 3 | Clinical Pathology Unknown Conference

1. Presented by Eugene Brooks, MD and reviewed by Sean Zhang, MD

An elderly patient presented with a chief complaint of shortness of breath and fatigue of a month's duration. The patient also reported occasional chills, night sweats and one episode of syncope. Their past medical history was significant for dilated cardiomyopathy for which the patient had an implanted cardiac pacemaker and defibrillator. Physical exam was notable for hypotension. Remarkable values from initial blood work are seen below.

	Value	Normal Ranges
Platelet Count	15 K/cu mm	(150-350 K/cu mm)
Prothrombin Time (PT)	57.5 sec	(9.6 - 11.8 sec)
Activated Prothrombin Time (PTT)	38.6 sec	(22.9 - 30.6 sec)
D-Dimer	>30 mg/L	(0.17 - 0.88 mg/L)
Galactomannan (serum)	7.89	(positive if >0.5)
Beta D-Glucan (1-3) (blood)	>500 pg/mL	(negative if <60)

An echocardiogram revealed a large mass involving the tricuspid valve with encapsulation of nearby defibrillator leads. The mass and leads were surgically removed and tissue submitted for bacterial/fungal cultures (results are seen below). Up to this point, all peripheral blood cultures were negative.

Fig 1: Calcofluor white stain of submitted tissue.

Question: The patient's presentation and laboratory findings are best explained by infection with:

Mucor racemosus

Aspergillus fumigatus species complex

Nocardia asteroids

Mycobacterium tuberculosis

Cryptococcus neoformans

21 thoughts on “Case 3”

Today, with all the fast way of life that everyone leads, credit cards have a huge demand throughout the market. Persons throughout every area of life are using credit card and people who not using the credit cards have prepared to apply for even one. Thanks for discussing your ideas about credit cards.

Thank you for your help and this post. It’s been great.

You’ve the most impressive websites.

Thank you for being of assistance to me. I really loved this article.

Thank you for writing this post!

Great content! Super high-quality! Keep it up!

I want to thank you for your assistance and this post. It’s been great.

Thank you for your articles. I find them very helpful. Could you help me with something?

Your articles are extremely helpful to me. May I ask for more information?

Please provide me with more details on the topic

I’d like to find out more? I’d love to find out more details.

Thank you for your articles. I find them very helpful. Could you help me with something?

There is some nice and utilitarian information on this site.

Very well presented. Every quote was awesome and thanks for sharing the content. Keep sharing and keep motivating others.

WOW! this article it really great i like it

Hey, i found a great site with so many games
Just click this >>> DetikToto <<<

I very delighted to find this internet site on bing just what I was searching for as well saved to fav

naturally like your web site however you need to take a look at the spelling on several of your posts. Watch bbc news fars

For the reason that the admin of this site is working no uncertainty very quickly it will be renowned due to its quality contents.

I really like your blog.. very nice colors & theme. Did you design this website yourself or did you hire someone to do it for you? Plz answer back as I’m looking to create my own blog and would like to find out where u got this from. thank you

I truly appreciate your technique of writing a blog. I added it to my bookmark site list and will

Nice post. I learn something totally new and challenging on websites

21 thoughts on “Case 3”

Leave a Reply