Cerebral Paecilomyces javanicus infection. An ultrastructural study.

A 41-year-old diabetic woman developed Paecilomyces javanicus endocarditis and subsequent cerebral fungal embolism and vasculitis with massive infarction and hemorrhage 6 years after a mitral valve replacement with porcine heterograft. The organism was identified by the culture from the infected brain tissue and aortic valve. Cerebral infection due to fungus Paecilomyces is rare. This report documents the cerebral manifestations of fungus Paecilomyces javanicus and describes for the first time the ultrastructure of such an organism obtained from the infected tissue. Their ultrastructural findings, similar to those described in Paecilomyces farinosus derived from culture, include a double-layered cell wall, a triple unit plasma membrane, abundant cytoplasmic lipid droplets, vacuoles, membranous profiles and septal formation. This report further demonstrates hyphae with packed 50A filaments and granulofibrillary material and features suggestive of intrahyphal hyphae, not previously described in fungus Paecilomyces.

Hirano body in an inflammatory cell of leptomeningeal vessel infected by fungus Paecilomyces.

An intracytoplasmic microfilamentous lattice, ultrastructurally identical to Hirano body, was found in an inflammatory cell within a leptomeningeal vessel wall infected by fungus Paecilomyces javanicus. The structure was well preserved and not associated with phagosomes. This is the first report of Hirano body found in an inflammatory cell at the site of fungal infection. The present finding suggests that the formation of Hirano body is non-specific and not restricted to the cell of the neuro-muscular system.

Signet ring cell lymphoma of the thyroid: a case report.

The first case of extranodal signet ring cell lymphoma involving the thyroid gland is reported in a 53-year-old woman with Hashimoto's thyroiditis. Since 1978, 24 cases of signet ring cell lymphoma, all involving primarily nodal tissue, have been documented in the literature. This rare neoplasm is believed to be a variant of non-Hodgkin's follicular lymphoma, which may be mistaken for metastatic poorly differentiated adenocarcinoma.

Nocardia asteroides aortitis with perforation of the aorta.

A 53-year-old man died of nocardial aortitis eight months after undergoing aortic valve replacement. Autopsy revealed vegetation in the area of a previous aortotomy incision and a small perforation of the aorta enclosed by pericardium immediately above the prosthetic valve ring. Prosthetic valve endocarditis was not present. Multiple splenic infarcts, microabscesses of both kidneys, and myocarditis were identified. Antemortem blood cultures and postmortem cultures of the aortic vegetation grew Nocardia asteroides.

Paecilomyces javanicus endocarditis of native and prosthetic aortic valve.

A 41-year-old diabetic woman developed endocarditis of the aortic valve caused by Paecilomyces javanicus six years after insertion of a porcine mitral valve heterograft. The patient died shortly after aortic valve replacement. Autopsy revealed vegetations of the aortic heterograft, valve ring abscess and ascending aortitis due to Paecilomyces. There was no involvement of the mitral valve heterograft. Lesions due to mycotic emboli were found in the kidneys, spleen, and brain. Cultures of the surgically removed aortic valve and of the kidney at autopsy produced rapid growth of P. javanicus. The gross and microscopic pathologic and cultural characteristics of this organism are described with a review of the literature. Previously reported cases of Paecilomyces endocarditis occurred only in prosthetic heart valves. This is the first known report of P. javanicus endocarditis of a native valve and its prosthetic heart valve heterograft.