Hemorrhagic pulmonary oxalosis secondary to a noninvasive Aspergillus niger fungus ball

• Published in: Virchows Archiv : an international journal of pathology 2007-12, Vol.451 (6), p.1067-1073
• Main Authors: ROEHRL, Michael H. A, CROFT, William J, QING LIAO, WANG, Julia Y, KRADIN, Richard L
• Format: Article
• Language: English
• Subjects: Aspergillosis - complications; Aspergillosis - diagnostic imaging; Aspergillosis - microbiology; Aspergillus niger - isolation & purification; Biological and medical sciences; Calcium Oxalate - chemistry; Calcium Oxalate - metabolism; Crystallization; Crystals; Fatal Outcome; Fungi; Hemoptysis - etiology; Hemoptysis - metabolism; Hemoptysis - pathology; Humans; Investigative techniques, diagnostic techniques (general aspects); Ionization; Kidney stones; Lung Diseases, Fungal - complications; Lung Diseases, Fungal - diagnostic imaging; Lung Diseases, Fungal - microbiology; Male; Mass spectrometry; Medical sciences; Metabolic diseases; Middle Aged; Other metabolic disorders; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Purines and pyrimidines (gout, hyperuricemia...); Renal Insufficiency - etiology; Renal Insufficiency - metabolism; Renal Insufficiency - pathology; Sarcoidosis, Pulmonary - complications; Sarcoidosis, Pulmonary - pathology; Spectrometry, Mass, Electrospray Ionization; Thromboembolism; Tomography, X-Ray Computed; X-Ray Diffraction
• ISSN: 0945-6317; 1432-2307
• DOI: 10.1007/s00428-007-0487-3

We report a case of hemorrhagic pulmonary oxalosis secondary to a noninvasive Aspergillus niger fungus ball. A patient with cavitary lung disease and hemoptysis developed progressive lung infiltrates and intractable metabolic acidosis leading to death. At autopsy, aspergillomas were identified in both the right upper and middle lobes surrounded by a large rim of necrotic and hemorrhagic parenchyma. Microscopic examination showed extensive crystal deposition and vascular thrombosis. Fungal growth was limited to the intraluminal mycelia, and no tissue or blood vessel invasion was present. Remote crystal deposits were also localized in the absence of fungal organisms to the contralateral lung and to the tubules of both kidneys. The crystals were birefringent in polarized light and stained with colloidal iron. X-ray powder diffractometry and electron impact ionization mass spectrometry identified the crystals as calcium oxalate monohydrate. Furthermore, non-necrotizing granulomatous lesions were identified in the lungs, liver, and spleen, consistent with sarcoidosis, and may have predisposed this patient to developing pulmonary aspergillomas.