Indian Journal of Pathology and Microbiology

IMAGES
Year
: 2012  |  Volume : 55  |  Issue : 4  |  Page : 589--590

Pulmonary aspergilloma with prominent oxalate deposition


Hiroko Kuwabara, Yuro Shibayama 
 Department of Pathology, Osaka Medical College, Osaka, Japan

Correspondence Address:
Hiroko Kuwabara
Department of Pathology, Osaka Medical College, 2-7 Takatsuki, Osaka
Japan




How to cite this article:
Kuwabara H, Shibayama Y. Pulmonary aspergilloma with prominent oxalate deposition.Indian J Pathol Microbiol 2012;55:589-590


How to cite this URL:
Kuwabara H, Shibayama Y. Pulmonary aspergilloma with prominent oxalate deposition. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Oct 25 ];55:589-590
Available from: https://www.ijpmonline.org/text.asp?2012/55/4/589/107838


Full Text

A healthy, 49-year-old male with a history of pulmonary tuberculosis consulted a neighboring hospital with a complaint of cough and dyspnea for 2 months. Antibiotics were administered for 2 weeks, but there was no response to the therapy. He was admitted to our hospital for further examination. A chest radiograph revealed a cavitary lesion in the upper lobe of the right lung. A sputum cytology examination showed Aspergillus and numerous calcium oxalate crystals, in addition to squamous cells and inflammatory cells [Figure 1]. Antifungal therapy and oxygen inhalation were performed, but the respiratory condition deteriorated. He died on day 12 after admission, and an autopsy was performed. The left and right lungs weighed 650 and 740 g, respectively. The right lung had a large cavity measuring 6 × 4.5 cm in the upper lobe [Figure 2]a. The cavity contained a soft blackish-brown material that had 3-6 μm diameter septate hyphae with narrow angle branching and blackish-brown pigmented fruiting heads, consistent with Aspergillus niger [Figure 2]b. The cavity was surrounded by fibrous tissue with numerous birefringent calcium oxalate crystals, neutrophils, and lymphocytes. Blood vessel invasion by A. niger was absent. There were oxalate crystals with histiocytic giant cells, neutrophils, and foam cells in the alveolar tissues around the cavity [Figure 2]c. The bronchial epithelium showed erosion with oxalate crystal deposition [Figure 2]d. No cavitary lesions were present in the left lung. The right neck lymph node had a granulomatous lesion with Langhans-type multinucleated giant cells, indicating an old tuberculous lesion. No acid-fast bacteria were detected on Ziehl-Neelsen staining. The aspergilloma in this case appeared to have developed in a tuberculous cavity. Oxalate crystals were also seen in the tubules of both kidneys.{Figure 1}{Figure 2}

The association of A. niger infection with oxalate crystal deposition in tissues is well documented. [1] Aspergillus species, particularly A. niger, produce oxalic acid, which reacts with tissue calcium to form calcium oxalate crystals. It is important to detect oxalate crystals for the following two reasons. First, the presence of oxalate crystals can suggest the diagnosis of aspergillosis, even when it is absent on slides. [2] Second, oxalate crystals induce lung and kidney damage, which occasionally leads to a fatal outcome. [3] In our case, pulmonary damage caused by oxalate crystal deposition in the alveolar tissues and bronchial epithelium, rather than Aspergillus itself, seemed to be the main cause of the respiratory failure. Oxalate crystals can be present in sputa, transbronchial specimens, and pleural fluids, and it is important to report the presence of calcium oxalate crystals in such specimens, because they occasionally induce a fatal outcome.

References

1Ghio AJ, Peterseim DS, Roggli VL, Piantadosi CA. Pulmonary oxalate deposition associated with Aspergillus niger infection. An oxidant hypothesis of toxicity. Am Rev Respir Dis 1992;145:1499-502.
2Procop GW, Johnston WW. Diagnostic value of conidia associated with pulmonary oxalosis: Evidence of an Aspergillus niger infection. Diagn Cytopathol 1997;17:292-4.
3Roehrl MH, Croft WJ, Liao Q, Wang JY, Kradin RL. Hemorrhagic pulmonary oxalosis secondary to a noninvasive Aspergillus niger fungus ball. Virchows Arch 2007;451:1067-73.