J-LSMS 2014 | Annual Archive

Figure 2: Initial CT of the chest showing diffuse nodular opacities and consolidation.

Figure 1: Violaceous, fungating, infiltrative lesion on the hard palate.

Figure 3: (H&E 200x) High-power image of the biopsied hard-palate lesion showing proliferation of atypical spindle cells within soft tissue. There are two cleft-like spaces with mildly enlarged endothelial cells in a background of extravasated red blood cells and chronic inflammation.

consolidation (Figure 2). Due to these findings and the lack of improvement, he was sent to the emergency department (ED). In the ED, he was visibly short of breath but without thrush or odynophagia. Review of systems was significant for decreased appetite, fatigue, night sweats, and cough productive of a large amount of thick, brown sputum. He was afebrile, with a normal blood pressure and pulse. Oxy- gen saturation on room air by pulse oximetry was 83%. The oropharyngeal examinationwas significant for the lesion on the hard palate previously noted, as well as a similar but

smaller lesion on the maxillary gingival mucosa. Lung exam revealed diffuse crackles and rhonchi in all lung zones, with decreased breath sounds at the bases. He had no skin lesions and no significant lymphadenopathy. The remainder of the physical examwas unremarkable. Initial laboratory assess- ment revealed a total protein of 5.9 g/dL (6.0-8.0 g/dL), an albumin of 2.7 g/dL (3.4-5.0 g/dL), a mild normocytic anemia, and mild hypokalemia. His white blood cell count was 9,200/µL (4,500-11,000/µL) with a normal differential. The patient was admitted to the hospital with a di- agnosis of multilobar fungal pneumonia and suspicion

J La State Med Soc VOL 166 September/October 2014 225

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