Characteristic clinical features of Aspergillus appendicitis: Case report and literature review

Figure 1 Computed tomography images. Computed tomography images of abdomen using IV non-ionic contrast and standard oral contrast demonstrates dilated appendiceal ostium and thickened appendiceal wall in cross-section (arrows in A); dilated lumen and thickened wall of vermiform appendix in longitudinal section (arrows in B); periappendiceal fat stranding (arrows in C) and an enlarged right psoas muscle with indistinct margins from local extension of the appendiceal inflammation (enlarged right psoas muscle with indistinct margins identified in D by 2 arrows, as compared to normal-sized left psoas muscle with distinct margins identified by 1 arrow). The appendix measures approximately 11 mm in diameter from outer wall to outer wall. All these findings are consistent with acute appendicitis. There is no evident appendicolith or typhlitis.

Figure 2 Photomicrograph. A: Photomicrograph of a hematoxylin-eosin stained, full thickness, cross-section of the resected appendiceal specimen shows a thickened appendiceal wall due to a severe mixed inflammatory infiltrate (A, low power). The high power view (A-inset) of an area within the low-power view, shows one questionable fungal hyphae (arrowhead) within a gland partially destroyed by the necrotizing inflammation; B: Photomicrograph of a Grocott-Gomori methenamine-silver (GMS) nitrate stain reveals invasive, septate, hyphal forms with acutely angled branches, characteristic of Aspergilus species (B-right side-low power, B-left lower inset-high power). The hyphae are confirmed as Aspergillus species by immunohistochemistry (B-left upper inset-high power).