case_images: PMC8064790_01
case_images: Autopsy findings and figures. (a) The normal lymph node architecture is replaced with granulomatous inflammation with abundant Coccidioides fungal organisms (hematoxylin and eosin stain 20X magnification. (b) Lymph node: Grocott-Gomori's methenamine silver stain (GMS) highlights Coccidioides organisms at 20X magnification. Note empty spherules and spherules filled with endospores. (c) Lung alveolar spaces are filled with caseating granulomatous inflammation with abundant Coccidioides spherules with and without endospores (hematoxylin and eosin stain 20X magnification). (d) Lung: GMS stain highlights Coccidioides spherules in the lung tissue. (e) Left lung: innumerable diffuse tan nodules show miliary spread in the upper and lower lung lobes with predominance in the upper lobes in the lungs. The lungs were grossly boggy and congested; the left lung weighed 1250 grams (mean 400 grams). (f) Right lung: innumerable diffuse tan nodules showing miliary spread in the upper and lower lung lobes with predominance in the upper lobes in the lungs. The lungs were grossly boggy and congested; the right lung weighed 1400 grams (mean 450 grams). (g) Lymph nodes are diffusely enlarged and display a homogenous cut white/tan surface. (h) Axial plane view of the CT scan of the lungs showing military pattern of distribution of innumerable centrilobular and paraseptal pulmonary nodules in a random/miliary pattern of disease. (i) Axial plane of the CT scan of the abdomen and pelvis showing multiple enlarged lymph nodes along the periaortic distribution, right external iliac, and internal iliac chains.
case_images: CRIID2021-8837493.001.jpg
case_images: PMC8064790_01_CRIID2021-8837493.001.jpg
case_images: fig1
case_images: COVID-19 which turned out to be negative. CT scan of the chest without contrast revealed extensive diffuse bilateral micronodules in a miliary pattern, mediastinal and axillary lymphadenopathy with pericardial thickening, while the CT scan of abdomen and pelvis revealed enlarged lymph nodes in the para-aortic, gastrohepatic, inguinal, external, and internal iliac chains (Figures 1(h) and 1(i)). There were innumerable diffuse tan nodules showing miliary spread in the upper and lower lung lobes with predominance in the upper lobes in the lungs bilaterally (see Figures 1(e) and 1(f). Coccidioides fungal microorganisms have spherules that may be empty or filled with endospores. Coccidioides fungal microorganisms are accentuated with Grocott-Gomori's methenamine silver stain (GMS) (see Figures 1(c) and 1(d)).The decedent grossly had extensive cervical, supraclavicular, inguinal, and axillary lymphadenopathy. The lymph nodes grossly showed a cut tan surface (see Figure 1(g)). Microscopically, normal lymph node architecture was replaced with caseating granulomas with Coccidioides fungal microorganisms that are accentuated with Grocott-Gomori's methenamine silver stain (GMS) (See Figures 1(a) and 1(b)).