Case 44

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

Clinical Vignette
An elderly patient with an history of extensive craniofacial squamous cell carcinoma status post resection, radiotherapy, hardware placement, and multiple flaps/revisions presented with complaints of an enlarging scalp "scab" and resulting in hardware exposure. Physical exam revealed a large ulcerated scalp wound with an overlying gray exudate. Of note, a 1,3- β-D-glucan test was positive 3 months prior, and Histoplasma antigen testing on blood and urine and fungal blood cultures were negative at that time. The patient underwent extensive wound debridement with replacement of hardware and repeat skin flap. Tissue from the epidural space was sent for bacterial, fungal, and mycobacterial cultures, and additional epidural tissue was sent for histologic examination. Histologic sections showed extensive necrosis and the organisms seen below (Figures 1, 2). Tissue cultures were also positive, with the slant and microscopic images below (Figures 3, 4, 5).











Question:
The morphology shown in the histology, culture and microscopic images above is consistent with which of the following?

 

31 thoughts on “Case 44”

  1. I’ve been surfing online greater than three hours as of late, but I by no means found any fascinating article like yours. It抯 pretty value sufficient for me. Personally, if all site owners and bloggers made just right content material as you did, the web can be much more useful than ever before.

  2. I couldn’t agree more with the insightful points you’ve made in this article. Your depth of knowledge on the subject is evident, and your unique perspective adds an invaluable layer to the discussion. This is a must-read for anyone interested in this topic.

  3. In a world where trustworthy information is more crucial than ever, your dedication to research and the provision of reliable content is truly commendable. Your commitment to accuracy and transparency shines through in every post. Thank you for being a beacon of reliability in the online realm.

  4. Your passion and dedication to your craft radiate through every article. Your positive energy is infectious, and it’s evident that you genuinely care about your readers’ experience. Your blog brightens my day!

  5. I simply wanted to convey how much I’ve gleaned from this article. Your meticulous research and clear explanations make the information accessible to all readers. It’s abundantly clear that you’re committed to providing valuable content.

  6. Your unique approach to addressing challenging subjects is like a breath of fresh air. Your articles stand out with their clarity and grace, making them a pure joy to read. Your blog has now become my go-to source for insightful content.

  7. I couldn’t agree more with the insightful points you’ve articulated in this article. Your profound knowledge on the subject is evident, and your unique perspective adds an invaluable dimension to the discourse. This is a must-read for anyone interested in this topic.

  8. I want to express my sincere appreciation for this enlightening article. Your unique perspective and well-researched content bring a fresh depth to the subject matter. It’s evident that you’ve invested considerable thought into this, and your ability to convey complex ideas in such a clear and understandable way is truly commendable. Thank you for generously sharing your knowledge and making the learning process enjoyable.

  9. I wanted to take a moment to express my deepest gratitude for the invaluable knowledge I’ve gained from this website. It has truly expanded my horizons, and I’m incredibly grateful. The information provided is not only accurate but also presented in an engaging and accessible manner. Keep up the fantastic work! See ya! ID : CMT-ROOE4ZLNTM4MDYJL2F

  10. Good web site! I truly love how it is easy on my eyes and the data are well written. I am wondering how I could be notified whenever a new post has been made. I’ve subscribed to your RSS which must do the trick! Have a nice day!

  11. Your storytelling prowess is nothing short of extraordinary. Reading this article felt like embarking on an adventure of its own. The vivid descriptions and engaging narrative transported me, and I eagerly await to see where your next story takes us. Thank you for sharing your experiences in such a captivating manner.

  12. I just wanted to express how much I’ve learned from this article. Your meticulous research and clear explanations make the information accessible to all readers. It’s evident that you’re dedicated to providing valuable content.

  13. Your storytelling prowess is nothing short of extraordinary. Reading this article felt like embarking on an adventure of its own. The vivid descriptions and engaging narrative transported me, and I eagerly await to see where your next story takes us. Thank you for sharing your experiences in such a captivating manner.

  14. This article is a true game-changer! Your practical tips and well-thought-out suggestions hold incredible value. I’m eagerly anticipating implementing them. Thank you not only for sharing your expertise but also for making it accessible and easy to apply.

  15. Your passion and dedication to your craft radiate through every article. Your positive energy is infectious, and it’s evident that you genuinely care about your readers’ experience. Your blog brightens my day!

  16. I couldn’t agree more with the insightful points you’ve articulated in this article. Your profound knowledge on the subject is evident, and your unique perspective adds an invaluable dimension to the discourse. This is a must-read for anyone interested in this topic.

Leave a Reply

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