case_images: PMC6501261_01
case_images: CT brain axial view demonstrating left frontal lobe mass concerning for glioblastoma.
case_images: CRIID2019-4352040.001.jpg
case_images: PMC6501261_01_CRIID2019-4352040.001.jpg
case_images: fig1
case_images: Due to his initial neurologic complaints, a brain computed tomography (CT) was completed (Figure 1), demonstrating a left frontal mass with surrounding cerebral edema and midline shift.
case_images: MRI brain axial view demonstrating multiple enhancing masses coalescing into a larger mass with surrounding edema resulting in midline shift involving anterior corpus callosum.
case_images: CRIID2019-4352040.002.jpg
case_images: PMC6501261_01_CRIID2019-4352040.002.jpg
case_images: fig2
case_images: Brain magnetic resonance imaging (MRI) (Figure 2) described the lesion as a conglomeration of multiple left frontal lobe enhancing masses causing midline shift.
case_images: CT chest demonstrating multifocal pneumonia in the left lung base with areas of suspected internal necrosis. No mediastinal lymphadenopathy is visible.
case_images: CRIID2019-4352040.003.jpg
case_images: PMC6501261_01_CRIID2019-4352040.003.jpg
case_images: fig3
case_images: CT of the chest (Figure 3) was performed for further characterization of the lung finding on CXR with the possibility of malignancy in question. It demonstrated a multifocal mass-like area of consolidation in the left lower lobe with necrosis and cavitation interpreted as a low suspicion for malignancy with close interval follow-up recommended (Figure 3).
case_images: Nocardia araoensis growing on cultures obtained from lung biopsy at 100x magnification stained with Kinyoun acid-fast stain.
case_images: CRIID2019-4352040.004.jpg
case_images: PMC6501261_01_CRIID2019-4352040.004.jpg
case_images: fig4
case_images: It was further speciated with matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS) and identified as Nocardia araoensis (Figure 4).
case_images: Cladophialophora bantiana showing septate hyphae with branching at 40x magnification from brain biopsy.
case_images: CRIID2019-4352040.005.jpg
case_images: PMC6501261_01_CRIID2019-4352040.005.jpg
case_images: fig5
case_images: Visual identification was made as Cladophialophora bantiana (Figures 5 and 6) after 20 days, referencing Larone's "Medically Important Fungi" text.
case_images: Cladophialophora bantiana growing on Sabouraud Agar from brain biopsy demonstrating velvety-textured olive-colored colonies.
case_images: CRIID2019-4352040.006.jpg
case_images: PMC6501261_01_CRIID2019-4352040.006.jpg
case_images: fig6
case_images: Visual identification was made as Cladophialophora bantiana (Figures 5 and 6) after 20 days, referencing Larone's "Medically Important Fungi" text.