case_images: PMC8787292_01
case_images: Macroscopic examination of the gastric, pyloric, and duodenal mucosa. Opening of the stomach showing presence of a brownish gelatinous material inside, (A) which, once removed, revealed an intact mucosa without signs of lesions (B). Presence of brownish gelatinous material in the duodenum (B) with no sign of ulcerative alteration of the pyloric and duodenal mucosa (C).
case_images: fped-09-764027-g0001.jpg
case_images: PMC8787292_01_fped-09-764027-g0001.jpg
case_images: F1
case_images: Macroscopic examination of the laryngeal cavity and tracheal lumen. Opening of the larynx, trachea, and bronchi with evidence of blood (A). Laryngotracheal ulcerative lesions with presence of some necrotic pseudomembranous-like features (asterisk, cricoid lesion; square, left anterolateral tracheal lesion; triangles, right anterolateral tracheal lesion) consistent with invasive Aspergillus laryngotracheitis (B,C); the insert in (C) shows a magnification of the site corresponding to tracheal wall perforation and thyroid artery damage. Histopathologic examination by hematoxylin and eosin of the laryngeal mucosa at the site of ulceration (transversal section), showing inflammatory infiltration and signs of tissue necrosis (Scale bar: 400 mum) (D). Grocott-Gomori's methenamine silver stain showing Aspergillus branching hyphae (black) infiltrating the laryngotracheal wall in a necrotic ground (E) (Scale bar: 50 mum).
case_images: fped-09-764027-g0002.jpg
case_images: PMC8787292_01_fped-09-764027-g0002.jpg
case_images: F2
case_images: Considering the laryngotracheal tract, three ulcerative lesions with destruction of the cartilage components were observed; necrotic pseudomembranous features were partly also recognized (Figures 2A-D). Specifically, the ulcers were located at the anterior aspect of the cricoid cartilage (circular appearance, 1 cm in diameter); at the left antero-lateral aspect of the first tracheal ring (circular appearance, 1 cm in diameter); at the right antero-lateral side of the trachea along the first tracheal rings (oriented according to the tracheal axis, 1 x 4.5 cm) (Figures 2A-C). An artery protruded at the cranial end of the right anterolateral tracheal ulcer (Figure 2C, insert). Specifically, all tissues underwent hematoxylin and eosin staining (Figures 2D, 3B,C, respectively) and the presence of hyphae was detected by Grocott-Gomori's methenamine silver (GMS) staining (Figures 2E, 3D, respectively).
case_images: Macroscopic appearance of the inferior lobe of the right lung after surface incision (A). Histopathological characterization by hematoxylin and eosin stain of the right lung parenchyma: hemorrhagic invasion of the air spaces (B) and the typical appearance of the tissue in interstitial pneumonia (C) were detected [Scale bars: 200 mum (B); 50 mum (C)]. Grocott-Gomori's methenamine silver stain showing Aspergillus branching hyphae (black) infiltrating the lung parenchyma (D) (Scale bar: 50 mum). Immunohistochemical staining for CMV, highlighting the presence of immunoreactive cells (E) (Scale bar: 25 mum).
case_images: fped-09-764027-g0003.jpg
case_images: PMC8787292_01_fped-09-764027-g0003.jpg
case_images: F3
case_images: Specifically, all tissues underwent hematoxylin and eosin staining (Figures 2D, 3B,C, respectively) and the presence of hyphae was detected by Grocott-Gomori's methenamine silver (GMS) staining (Figures 2E, 3D, respectively). Regarding the lung tissue, focal areas of necrosis, likely associated to Aspergillus infection (as confirmed by hyphae presence) and interstitial pneumonia evidence, consistent with CMV etiopathogenesis, were observed; hemorrhagic invasion of airspaces was also found (Figures 3B-E).