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Discussion Starter · #1 ·
A 47-year-old Caucasian male undergoing treatment for chronic myeloid leukemia (CML) complains of headaches and scant nasal discharge. Physical examination reveals tenderness over the paranasal areas. Biopsy of the sinus mucosa reveals the findings below.


Which of the following is the most likely cause of this patient's condition?
A. Malassezia furfur
B. Microsporum canis
C. Rhizopus species
D. Aspergillus fumigatus
E. Candida albicans
F. Cryptococcus neoformans
G. Blastomyces dermatitidis
H. Histoplasma capsulatum
I. Coccidioides immitis
J. Sporothrix schenckii
 

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I'll go with D as well

I like D. Aspergillus also.

Great question! I like the immunosuppression in the leukemia pt - good practice or finding clues in the presentations..:)
 

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Discussion Starter · #6 ·
sona jorgemorales and Mondoshawan all three of you are correct.

The correct answer is D) Aspergillus fumigatus

Let me give you the full explanation why D) is correct:



The image above shows fungal hyphae branching at acute angles in a V-shaped pattern. This is the characteristic histologic appearance of Aspergillus fumigatus. This fungus is widely distributed in the environment and commonly grows on decaying vegetables. It is monomorphic, existing only in mold form (with multicellular hyphae).

Aspergillus can cause the following conditions:

1. Invasive aspergillosis develops in immunosuppressed patients. The neutropenia associated with leukemias and lymphomas is strongly associated with invasive aspergillosis. The lung is the area most commonly affected. Patients present with hemoptysis and lung granulomas. Aspergillus has a predilection for blood vessels, spreading hematogenously and potentially causing tissue infarcts in the skin paranasal sinuses, kidneys endocardium and brain. Diagnosis is made by light microscopy of tissue specimens, which reveal V shaped, branching septate hyphae invading the tissue. Amphotericin B is used to treat invasive aspergillosis.

2. Aspergillus can grow in old lung cavities (produced by tuberculosis or bronchiectasis), forming aspergillomas, also called 'fungus balls." Fungus balls grow inside the cavity only; they do not invade the surrounding lung tissue. Aspergillomas can be surgically removed.

3. In patients with asthma Aspergillus can cause allergic bronchopulmonary aspergillosis (ABPA). Patients present with wheezing and migratory pulmonary infiltrates. Increased serum IgE and increased titers of antibodies against Aspergillus are characteristic. ABPA is treated with steroids.
 

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Discussion Starter · #7 ·
C or D , I think it's C
Thanks for trying to answer this question. I know why you are thinking choice C) Rhizopus species, coz it can colonize in the nasal mucosa but.....Rhizopus and Mucor cause mucormycosis. The typical presentation is a paranasal infection in a diabetic patient. Unlike Aspergillus 45 degree, Mucor and Rhizopus form broad non-septate hyphae that branch at right angles 90 degree.
 
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