Case 41

1. Presented by Alisha Ware, MD and reviewed by Sean Zhang, MD, PhD.

Clinical Vignette

An elderly patient with a history of bilateral lung transplant for chronic lung disease reported one month of worsening dyspnea on exertion and a recent decrease in pulmonary function. The patient also reported recent steroid use. On presentation, the patient was noted to have hyperkalemia and neutropenia. Of note, the patient was also being treated with valganciclovir for CMV viremia. A chest x-ray was unremarkable. A bronchoscopy with bronchoalveolar lavage and transbronchial biopsy collection was performed. Bacterial and fungal cultures were performed. The bacterial culture was negative. The fungal culture was positive and revealed the organisms seen below (Figures 1, 2).


The culture and microscopic images shown above are most consistent with which of the following?