case_images: PMC9899447_01
case_images: Brain magnetic resonance imaging findings of a 53-year-old woman with acute myeloid leukemia and multifocal cerebral lesions caused by Hormographiella aspergillata: (a) initial axial post contrast T1-weighted scan shows two gadolinium enhancing lesions in both frontal hemispheres with minor mass effect on the right side with a leptomeningeal enhancement on the left (arrow). (b-e) Follow-up imaging: (b) axial post contrast T1-weighted scan displays the progression of the gadolinium enhancing lesions compared to (a and c) sagittal post contrast T1-weighted scan showing a frontal as well as parietal lesion with the same lesion characteristic as in (a-d) The FLAIR image shows the amount of surrounding edema with different extent between the two lesions. (e) Susceptibility weighted imaging demonstrates signal loss due to paramagnetic effects caused by iron deposition/microhemorrhages.
case_images: SNI-13-596-g001.jpg
case_images: PMC9899447_01_SNI-13-596-g001.jpg
case_images: F1
case_images: After the occurrence of paresthesias and hemiparesis, brain magnetic resonance imaging (MRI) showed multiple gadolinium-enhancing cerebral lesions [Figure 1a]. The lesions were characterized by signs of microhemorrhages and perifocal edema [Figures 1b-e].
case_images: Microscopic examination of the stereotactic biopsy of the right-sided frontal lesion. Periodic Acid Schiff staining. (a) Hyphae with a string-like appearance and bulbous beads (arrow) on the background of necrotic CNS parenchyma; (b) focally branching hyphae (long arrow) and partly septate hyphae (short arrow) can be identified. Only single lymphocytes and macrophages are found within the necrosis.
case_images: SNI-13-596-g002.jpg
case_images: PMC9899447_01_SNI-13-596-g002.jpg
case_images: F2
case_images: Schiff (PAS) staining [Figure 2]. Some of these had a string-like appearance and developed bulbous beads.