Aspergillus colonization in hydatid cyst: Addition of a case
A 52-year-old non-diabetic gentleman presented to this hospital with complaints of cough with productive sputum, anorexia and mild weight loss for the last four months. He had similar episodes of cough two years back for which he had been evaluated elsewhere. He did not have any other significant past medical history. General and systemic examination was unremarkable except for decreased breath sounds over the left lung fields. Hemogram was unremarkable. He was HBsAg and HIV negative.\nSputum culture did not reveal any specific findings. Pulmonary function test showed a combined restrictive and obstructive ventilation defect with mild airflow limitation. Chest X-ray showed a circumscribed cystic lesion in right lower lobe of lung. Tomogram chest showed soft tissue opacity in left mid and right lower zone with thickening of fissure on left side. Plain and contrast CT revealed a well-defined peripherally enhancing thick-walled cystic lesion of size 65 × 52 mm in the apical segment of left lower lobe []. The lesion showed tiny air pockets within the cyst (meniscus sign). Another similar smaller lesion was seen on right side. CT abdomen showed enlarged spleen with a lobulated non-enhancing lesion of size 31 × 42 mm near splenic hilum and similar smaller lesions anterior to bladder and rectum. With these findings a diagnosis of disseminated thoraco-abdominal hydatid disease was made.\nIn view of the present respiratory complaints, the patient was taken up for surgery, first on the left side. The thorax was opened via postero-lateral incision and the lesion was approached via the fifth intercostal space. The cyst was identified, pericyst was incised and cyst was anucleated. The specimen was submitted for histopathological evaluation. Grossly, the specimen measured 8 × 9 × 6 cm. The external surface was shiny. It yielded 10 cc of slimy turbid fluid. The inner surface was yellowish with focal brownish black granules [].\nHistological examination revealed lamellated hyaline eosinophilic membrane of hydatid cyst. The inner wall of the cyst showed dense lymphoplasmacytic inflammation and Splendore–Hoeppli composed of amorphous eosinophilic granular material with entrapped fungal hyphae. With Gomori's methanamine silver (GMS) stain, the fungal hyphae were slender, septate, branching at acute angles, morphologically compatible with Aspergillus species. The fungi were also stained with Masson's Fontana (MF) and Periodic Acid Schiff (PAS) stain []. The tissue was not submitted for culture.\nThe patient was prescribed 10 mg/kg/day of oral albendazole for 3 months.