case_images: PMC10714052_01
case_images: Plain radiographs of the pelvis (a) and left thigh (b, c) show multiple areas of osteolysis in the proximal femur with gross deformation and cortical breach. Numerous moth-eaten and permeative lucencies throughout the proximal and shaft of the femur can be appreciated. There is no apparent periosteal reaction or soft tissue component.
case_images: qmj-2023-03-025-g001.jpg
case_images: PMC10714052_01_qmj-2023-03-025-g001.jpg
case_images: fig1
case_images: There were no noticeable periosteal reactions or soft tissue components (Figure 1).
case_images: T2-weighted coronal images of the pelvic region show multiple rounded hypointense lesions scattered in bilateral pelvic bones, bilateral proximal femurs, and the lumbar fourth vertebra.
case_images: qmj-2023-03-025-g002.jpg
case_images: PMC10714052_01_qmj-2023-03-025-g002.jpg
case_images: fig2
case_images: A large heterogeneous T1- and T2-weighted hypointense and STIR hyperintense lesion involving the left proximal femur, neck, intertrochanteric region, and proximal shaft, with areas of cortical break and periosseous soft tissue edema, were observed (Figures 2-4).
case_images: Magnetic resonance imaging sagittal images of the left thigh show a large heterogeneous T1-weighted (a) and fat-suppressed/ short tau inversion recovery (STIR) (b) hyperintense lesion involving the left proximal femur, neck, intertrochanteric region, and proximal shaft with areas of cortical break. Multiple other round lesions are present in the femur's mid and distal shaft.
case_images: qmj-2023-03-025-g003.jpg
case_images: PMC10714052_01_qmj-2023-03-025-g003.jpg
case_images: fig3
case_images: A large heterogeneous T1- and T2-weighted hypointense and STIR hyperintense lesion involving the left proximal femur, neck, intertrochanteric region, and proximal shaft, with areas of cortical break and periosseous soft tissue edema, were observed (Figures 2-4).
case_images: Magnetic resonance T1-weighted axial images of the proximal left femur show multiple hypodense lesions in the neck, intertrochanteric, and proximal femur (a), and T2-weighted coronal images of the left thigh showed perosseous edema and edema of the adjacent muscles. Posterior and medial cortexes are eroded, and soft tissue within the bone extends into the adjacent perosseous plane (b).
case_images: qmj-2023-03-025-g004.jpg
case_images: PMC10714052_01_qmj-2023-03-025-g004.jpg
case_images: fig4
case_images: A large heterogeneous T1- and T2-weighted hypointense and STIR hyperintense lesion involving the left proximal femur, neck, intertrochanteric region, and proximal shaft, with areas of cortical break and periosseous soft tissue edema, were observed (Figures 2-4).
case_images: Hematoxylin and Eosin-stained section reveals necrotic bone, inflammatory granulation tissue, and narrow-branching septate hyphae (arrows) [100x (a) and 400x (b)]. (c) PAS (periodic acid-Schiff) stain reveals necrotic bone with branching septate fungal hyphae diagnostic of aspergillosis (arrow) (400x). (d) Gomori methenamine silver (GMS)-stained section reveals the characteristic grayish black branching septate hyphae of aspergillosis (arrow) (100x).
case_images: qmj-2023-03-025-g005.jpg
case_images: PMC10714052_01_qmj-2023-03-025-g005.jpg
case_images: fig5
case_images: Gomori methenamine silver (GMS)-stained sections revealed the characteristic grayish-black branching septate hyphae of aspergillosis (Figure 5).