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case_images: (A) Chest CT scan showing patchy ground-glass opacity, bilateral consolidation, and atelectatic bands. (B, C) Paranasal and orbital CT scan displaying opacification in all paranasal sinuses, destruction of medial septum in the left maxilla, bilateral retrolental fat haziness, medial extra and intraconal fat haziness, and inflammation of medial and superior rectus muscles. These findings suggest a fungal sinonasal invasion in the right orbital.
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case_images: A chest CT scan revealed a mix of patchy ground-glass opacity (GGO), bilateral consolidation, and atelectatic bands ( Figure 1A ). These findings indicated a fungal invasion of the sinonasal region in the right orbit ( Figures 1B, C ).
case_images: (A) Direct microscopic examination using 20% KOH revealing hyaline hyphae (x400). (B) Histopathologic examination with H&E staining showing infiltration of acute and chronic inflammatory cells, bleeding, and fungal hyphae (x1000). (C, D) Surface and reverse isolated colony after four days of incubation at 25 C. (E) Microscopic appearance of the isolate as observed on a slide prepared from the fungal culture (x400).
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case_images: Microscopic examination of the clinical specimens obtained from the paranasal sinuses and necrotic tissues using KOH preparation showed the presence of hyaline hyphae ( Figure 2A ). Histopathological examination with hematoxylin and eosin (H&E) staining revealed infiltration of acute and chronic inflammatory cells, bleeding, and presence of fungal hyphae ( Figure 2B ). Sabouraud dextrose agar (SDA) plates, resulting in colonies with abundant aerial mycelium that appeared white and cottony ( Figures 2C, D ). Slide culture and aniline blue staining of the colonies indicated the presence of Fusarium spp. ( Figure 2E ).
case_images: PMC10538539_02
case_images: (A) Chest computed tomography scan demonstrating atelectasis in the right lower lobe, patchy consolidation in the left upper lobe, bilateral patchy ground-glass opacity, bilateral pleural effusion, pericardial effusion, right collapse consolidation, and air bronchogram. (B, C) Paranasal CT scan showing bilateral medial and sphenoid opacification, ethmoid destruction, medial septum destruction in the left maxilla, and bilateral frontal mucosal thickening.
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case_images: A chest computed tomography (CT) scan conducted on day 1 revealed multiple abnormalities, including atelectasis in the right lower lobe (RLL), patchy consolidation in the left upper lobe (LUL), patchy ground-glass opacities (GGO) bilaterally, bilateral pleural effusion, pericardial effusion, right collapse consolidation, and air bronchogram ( Figure 3A ). A paranasal CT scan revealed opacification in bilateral medial, sphenoid, and ethmoid sinuses, as well as destruction of the medial septum in the left maxilla and nasal septum, and bilateral frontal mucosal thickening ( Figures 3B, C ).
case_images: (A) Direct microscopic examination using 20% potassium hydroxide revealed septated hyaline hyphae (x400). (B, C) Histopathologic examination with hematoxylin-eosin stain showing infiltration of inflammatory cells (PMNs), fibrinolocyte exudate, septate acute angle fungal hyphae, and conidial head (x1000). (D, F) Morphological characteristics of colonies on Sabouraud dextrose agar after four days of incubation at 25  C. (E) Microscopic morphology of Fusarium observed at x400 magnification.
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case_images: During the procedure, necrotic tissue was removed, and KOH microscopy examination ( Figure 4A ) identified the presence of hyaline septate hyphae. Histopathology examination showed infiltration of inflammatory cells (PMNs), fibrinolocyte exudate, septate acute-angle fungal hyphae, and conidial head ( Figures 4B, C ). The isolated colony grown on SDA culture exhibited abundant white cottony mycelium and a purple undersurface ( Figure 4D ), and microscopic examination of the colonies confirmed the presence of Fusarium spp. ( Figure 4E ). Additionally, colonies of Aspergillus flavus with a yellow-green surface, white border, and velvety to cottony texture were observed ( Figure 4F ).
case_images: PMC10538539_03
case_images: (A) Chest computed tomography scan showing bilateral disseminated mixed ground glass and consolidation suggestive of COVID-19. (B) Paranasal sinuses demonstrating fibrino leukocytic exudate, necrosis, and destruction of the nasal septum. (C) Direct KOH microscopy of tissue samples revealing hyaline septate hyphae (x400). (D) Histopathological examination of tissue sections revealing necrosis, edema, bleeding, and irregular and acute angle septate hyphae (x1000). (E, F) Reverse and surface of the isolated Fusarium solani colony on Sabouraud dextrose agar after four days of incubation at 25 C. (G) Microscopic morphological characteristics of the isolate in slide culture at x400 magnification.
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case_images: A chest CT scan revealed bilateral disseminated mixed ground glass opacities and consolidations, indicating a possible case of COVID-19 ( Figure 5A ). Paranasal endoscopy revealed the presence of fibrino leukocytic exudate and necrosis, along with the destruction of the nasal septum ( Figure 5B ). KOH direct microscopy of the surgical biopsy specimens revealed the presence of hyaline septate hyphae ( Figure 5C ), and histopathology showed evidence of necrosis, edema, bleeding, as well as irregular and acute-angle septate hyphae ( Figure 5D ). SDA agar plates initially produced white and cottony colonies that rapidly developed a violet center with a lighter periphery ( Figure 5E ), with the reverse side appearing light but deeply colored ( Figure 5F ). Slide culture and aniline blue staining of the colonies confirmed the microscopic morphology indicative of Fusarium species ( Figure 5G ).