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Tm!DR Slll-li !iAR COLL:CTIOli
SET VI!1
?un~, ~~r, l94l, Ba.i:.er
1. Li"'Ye·r - atreptothr1x 2. Lttnga ~ "' S. Kid ney - • ~. Lymph node - biatoplumo'oh S. LiTer • " 6. Spleen - •otinomyooaia 7. Cerebellua - • 8. Aortic ~al•e - " 9,
10. u. u. 13. u. 15. 18. 17. 18. 19. 20.
24. 25. 26. 27 . 2B.
Polyp ot nooe - llh1nooporidios1a Muaolo • ~ram stain • Nocardioaie Foot - nooardiooio (aotino~oooto) ll!.duro n,yeooio (probt.blc n10nooporlwo cpiooporua) Brain - &r&D stain • oryptoeocooaia L-vJ:Il: - oryptocooood 1
Brai~. oryptoeooooa1a (Bodian e1l•er and c&r~ne) · Bro.in - DUOOroii'(YOOeil Skin - ohromoblaato~oosia Skin - • Luns .. oooo14iodo~ooa1e
Lu~- " LiTer - " .. South American Ble.ato=;yoosis f--'m "·'eft, Lung - North ~rioon Blootomyoooto Skin - Bl~atomyooo1o Adrenal - BlOJtomyoooio OesoP.•su• - Moniltuh 5Xperi1110ntal sporothriahosis - mouoe -- /(f Lung - aopergillosio
- Z- sG. 4" (,. tii(,..
L4f '"trt.•
..,
r;i) .. '! , 2, s
Auto psy #3794
L. w., a ~ite man, S2 yoars of age tirat entered Barnes Ho•p1tal in ~obor , 1928. He complo!nod ot a rather eudden increase of 40 pounds 1n woisht 18 mont h• b efore, whioh was r educed to hh normal 160 poundo b y d iet , M4 .welling of t he ankleo, polyuria, rat1suoob111ty and pain in the buttocks . Paml.ly, oooi al and past hiatorice were 1rre1onnt. A hypertension of 188/140, a c:encrali&ed pu_rpure., edema, Wee 14, 000:w1 thout a differential ahift a.Dd arine ot fued l ow apeoifio &rATity were tho 1-.portant tindin&•·
Be wu read!:dtted two mntltsllater at whiob ti ... the only s1pl11'ioo.nt tddit1on WAS the diagn01l1 ot ~r&e~wre Of the 1~ thOT&CiO and l at lumbar Tertebrao.
Ho returned agAin 5 months l ate~. ""y 1929, oompl aining of hoving had a oou&)\ f or 3 tnOntha with aoco produotion of eputum. i n tho mrning, and pc.i.n in the risht chest . A culture trom o. ri~ht hydrothorax i!lll!le<!iately before h6d revooled .streptothrix. He had a. ae.&Jl aubout.r.noous ab.aoeu on the right ebeat And right hydrothore.x . S!.reptt>thrix was re-coTered from JlllmeraU:s sites tnoludln& spttu=, the abeoeuea. and the pleuro.l oarlty but not t ho blood. Jty abaoo••e• appeued and they were drained.. Hh purpure. he.d dlao.ppe:arcd but hi• ecleu. rewrred. During hia _last woek:: ho developed hi~h t eTer t or the tirat time, rapid puloc and his leukocyte oount pcraist ed at 15 ,000 to 43,000. Ha deTolope<l ineroaai~ rotpiro.tory diffioul ty o.nd died quietly w1tho\lt "t,.-tdenao ot neurol ogical 1n• olverncDt ..
no baoteriologioal report given.
Autopsy observations:
Generally disse=Lno.ted Strepto thri x inteotion
Sections :
!hl a is the ease reported. Yabero., 2Zt 233- 266, 1930.
"'" ,.;;J;orf ~ Autopsy #9B8Z , f9" fiUII"
No. 4
J . D. J . This 11 1:10nt1ta o ld white ""'l e develo ped impeti&onouo old.n f\)ftl·\~ lelion.s a.t -the age or 4 do.,.. . S1nee then thele have dlse.o"Oeared end re- rJ appeared. , under a variety of loctU :medlca.t1ona . Be ga:o:'e c.· h.latory ~t t req-.1.ent ~· colds all during t he pa•t winter, with constant cout;b. Durin.s t h.o pliat week ht had deYe)Oped dyspnea, faat pu.lee, S OJEie oyo.noaia and an AbljiOCII in the r1sht anterior nasal orifioa . Ue then beoamo muoh mor e il l . with progres~ive ~ea.knoeo nod a weakened ory. The past !listory rovoaled no othor illnesses . ~ -1"' Family history non-contributory. ~ -vuktt · ~
Heo.rt• • blood - Bhtoplo.a,..::~p!Ulat= ~D<i St apb. aurcue I· (. ? Swaba ft'Otl the s pleen and the liver ... hc::rolytic Stpahylococous &lbus ~~t CUlture or ::o.oerntecl luDf! • 1!1stoplo.&toA oapeulet= 'l-' I
/~,utopay Observations: Hiatoplaa~oa{a invol~n~ the }Ul~l, liTer, Spleen kidneys And 1~
aodoa of the ~iastinu=, peri&ortio regions ~nd ot the mesonteriea of the intestines
Hyporploei~ of tho oploon nnd of tho lymph follioleo of tho l>rge intettlne
Acute uloers ot tho oolon Poteohiao of' the sld.n o.nd o.£ the a.rm.s, legs and the tru.nk Ulcers ot tho skin, of the held, bact and l ees Subautaneoua edema of the so~lp
Seotiocs: LynJ:t> mde
NO. 6 Autopey -Ill 04(.0
s. !.!. B., a 4 yeo.r old nita felllllle admitt ed to Children'• Ho s pital f or the first time wi th chief complaint& of bronchopneumonia, 4 weekSJ swollen &l&.."lde, 2 weeksJ loss or appetite, 2 weeke; loaa o.!' wei&ht ot S-10 _pounds , 4 wselco . Thia child io • twin with birth wei&ht of 7 pound• and 3/4 oune .. and waa a norce.l full t ·erD. Tho patient ate poo rly a.ud W'a.i broat t ted tor 2 weeki, Thea a foedinss were f ollowed by Pot milk a.M. eow' 1 rrl.lt tha t wu JlOt: plt tour1ted. Thle child h&a novor done well stnoc bronohopneumonia at the age of 4 snth6. Tho child had. t:~easles a t 1 year and h o.s been dr' nktnc un-posteuri.tod mille. Four weeks prior to admi .. ion the child had bronchopneumni& t or 2 weeks that was f o llowed b y swol len ' l ands in the oenical re&lon. One of these wu b1op~1od cDC! ~ diegno• ls or Hodckin• • diseue ns. Mde . the .e l ic!e.e were not seen by the at~f of Ch ildren ' • Hospit&l . The child has had • morked l oss weight and loss of appetite during the 2 weeks prfor to o4ciss ion. The tNnily hi story is non-contributory. ,
Heart '• blood - .Ub lif!eneo fooolis and hiato pl~>"""' capsulatua Swab trom peritoneum - tlo g:rovrth Snb fron l eft pleural <>OYi ty - !lo U Orih S'wab trom loft l ower l obe - Alka.ligenes f ocelia and Ne-is t erie oo.t .arrhe.lis Node - Histoplasma oopsul a tum and F~lcnligones f eoalia nnd diphthero id s
(2 t ypes) Sectio ns : Li~er
Autopsy~~servat1ons:
· • · Histopl asmos is involvins all lobe• or the lungs o.nd lymph nodes o f tho medio..s tinal , por te. hepe.t1o and per ia.ortio vol.1ps
YAoular orupt1ons of skin J~~
!~!:0(200 oc . ) {~;;).·~_.,.~ Splow:>ogaly ( 200 gr.,.) ~·~ I ~i. ~O ~
6\ & 7 ~ .;::., ~,....,.... r · No .
Autopsy #S8S3
It. R., n white wo=tt.n. 43 yctt.r3 ot tl!;O wa.s e.d..clltted. t o 8-ernee: itoapito.l iu July, 1940 wi t h complc.i nt s o i" int r ao:tible -productive cough occn:;io nally aooo~ied by blood tingeo sputtlO. c f 4- "lmnfus durntlon.. Shv &:lve a pc.s:t hist "Jry- Of l\J1._ cpi sX.c.. o f t:tlr :ked pu11!lOD:lr'Y SO?Sit &:ld hC=>i't:,~Si1 15 year s bcf oro . Bar J'lusbn.nd: hc.d d i ed 4 yetlro beror c o f a lung compl ni nt ofjndefini t o n!\tur e . 4
~ly, so~1al and past hiatorlad ~ere ot hersi• c irrelevtlnt . Her present •
~ ~Jii-r;..., ~ ~---. ... . I.P-. ........ :~;, "' ~ r
Ulnesa had started w·ith 4 ri&}lt sided pnowronia.. A dl.o.gnoais of bronchi.coto.ola ot th~ lower lobo or the r ·ight lunc wo..s eatabl!shed by bronohoscopy e.nd X-ra.y 1tudles. An a.neiDia of about 3 mllion erythrocyte• was. p:-oeent but no oth.er ll.bora.tory .tihd-lngs were or $i¢r1ce.neo, inoludin& examin1.tion and oulturo of tho ap~>tum.
A month la.ter a lobecto=:r was pertorted and conn.leteenco wu eompl1-oa.ted by devolopaent o.f an ecpyew. . .t.n iritis slao a.ppe.s.rod which later responded to therapy. She then began to become o.plthetie ond disoriented . A week lotor she developed & l eft aideit weakru>ss and then suddo.nly hod e. ri&ht aided oonTUlsion. While atillrintermit tently ration~l sho complained of lett upper quadrant pain aocentuc.ted by res?ir·at1on. iier course wa.a downhill; ahe bee~ conetoao, oontiagod to havo oonvul1ive ~vo:ents . and expired Sept . 9, 1940, a. JIX)Uth G.tter her operation.
. .
Heart' • blood- Sterile Parl.oto.l lobo or lett hemisphere or 'br&l.n - No &rowth Splenic abeoees - Bomolytio Staphylococcus aurous and non~hemolytie
streptococcus CerTix or uterus - HeMlytic Ste.phylococcus aureus and. diphtheroid baoU 11
Autopsy Obeervations:
AotiDQ~OOSis or the s pleen and ~rAin with multiple •bsceSIOI Multiple absoesses of tho liver
Sootioru1: Spleen. cerebellum
• .,. 8 loltopsy #10297
F. '! ., 6. white ma.n, 65 yaara of" age wa.1 f irst o.dmittod. to Barnu Hospital with coiRplo.l.nts relo.t1Te to his t1no.l illneu l.n Juu, 1942. He co~Rplal.ned or wulalou, lett upper quadrant p&l.n and lo10 of wol.!;ht at that ti.Jie. Sl.g~cAnt findings wer e A moder ate ~nemia or 2 million, total set"Qm proteins of 8 .2 grams with 5 .2 gro.JM globUlin, enlar~;ed l1Tor and aploen and an eortic d!e.st~Uo nlTl!l.lr without aigns of peripheral failu.re. He bad leaiona of erytheu :ultifor:e o n hie right ha.r::d .
On readndseion $1x months l ater he had continuing complaints or ~norcx1A, diuinesa, headaches. pain 1n tbo ri~ht an\, occa.a1onal l1_cp1ng when e..ble ~ Wl>rk and oec!I.Oio~>ol awelUn& of the a.nlc.lea 1.!1 tho nenln&• On the DOrci.n& of admaoion he .... round lying on the 'bathroom noor lllJ:abl1ng unbtoll l.gibly. He -was oomatoae and eyanot1e .. Thore was oomplet e flaccid paralysis of the lett- arm 11nd log, the saoo a.l'!emia. w.b .o. or 17, 000 .. "ith l ett S:hitt Md lil'!l of 95. Luri>&r puncturo returned grouly bloody rluid under inere•oed pressure ~ Blood culture was reported u conte.inill6 he-r»lytic sta.phylococcua e.lbus .
Ho failed to respond t o therapy 11cd died two days l ater, January 17, 1944.
Bactcriol ogicOl Examination,
lleo.rt • 8 blood ... Aot!nomyoos g;r&J:dnia Vegctc..tion1 !"rom the val•ea of -the hear-t - Aotinonycos gr8.111.Dis !md
Proteus vulg11ria
Autopay ObaerTations:
Subaouto bo.oterh.l endoc;e.rclitia in'rolTi~ aortic ..,.a.lve aurte.oe Of anterior lea.fletG ot mitral To.l..,e
Petechiae of the skin over antecubital tosaae p,rtially heal ed inferat ot spleen Chi'Qolo endocarditis ot mt:ral 'f'8l'f'e,
Sections 1 Aor-tio v-.lTe
No . 9
lihinasporidialis. P'Unps 38 .
1Jo ctata. Spe-oimen h pre.sunably a }\a.Sal Ml~.
~-
{~tt ~(Z~o. lO
and the anterior
Clinloo.l Note: "lbe patie-nt t:!lS e. can, aged 63, ..mo entered the hoapito.l two ~ one-b~lf ~ntha b~fo~c death with oougb, foTer, nnd loes ot 18 ~· of wel¢ in two cnntha . He Md ~derCLtely sovere but well controlled d i o.betos. t ... c.y revoa1ed mottlin& or tho l ung fiolds. Tho white blood eount """ 30, 000 w1.th 86% polymorphonuclear neutroph1ls. SUbcutaneous nodule& eventually tppearod nnd a tungus wa.s isolated tr.om the sputum and aubout.tlne?us o.bsces••• · An aerobic 'broth blood cul tur~ taken 8 de.ya before death showed tho same t'ungus after 2 weekR &rowth. Th.,is culture froQ the blood stre4la wa.s su'b~tt.ed t<> Or. C. 'II. Ehmono ~t tho lie.t\onal I""titute or Health, ..no olusified it 08
Aotino5fCo8 asteroi dea. Later it was examined by Or . N. f· Conant ot Duke Uiavereity, who e.creed a dittgnosit, but preferred the terminology Uoca.rdia uteroides. Sul£nd1at1ne Appeared to oheok the progress ot tho disease in the sense Of reducing the tover but tho ?nt1ent eventually died on ~y 11~ 194-S. .
Pt.tholog:y t Autopay roTealcd au.ltiple abscesses in tho lll.nia, aubou.to.nooua \\J' tiasuo, s·kolete.l t:DJ.&oles , hoart, nnd Jddney1 , but- lXInc ic. the liver. H1atolo~i/ V"'
eolly t~j·~:;nt;:;:;oni;:~~r~~ f;GJ! w~,~,?/~
:J(~~No.ll r~~~~~ NOoard iosio (aotino~eosio of toot ) or }.(yoetomo. due to Nooardio. (/ .. etino?Yces) asteroidea. ~
Duke Surg1ool l Pathology No . 52900 . H. t.nd E •• otain. (}A;~~. '1111te ...., or 69 )'e&rs h&d pnin """ awellin~ of hi• rigbt foot ~.tr:-~1. . sb JDOnthS betore &:~:potation. Be Ia>.., or no preceding iojury or intootion or tho foot. A month before e.mpu-to.tion o tluotuan-t s-wellin,; ot the toot wa.a
luced I.DCl other 31lnuses developed. Granules were ~ee.n in treah prepu-at.ion.s ot the pus and Hocardia (Aet.:tnO~·cel) utoro!.des, a.n aerobic &otlno=:ycete, .e..s Ctlltur.d troD the &ramiles. 'there 'lnl.O DO OT.idenoe Of infection elanbare to the body. The leg wa.s &nJlllhtod below the knee. A picture of a •C&ittal NCtlon ot the root 1~ shown AS Pi&· 6:52 in tt&eaotion to Icjury, " Forbus~ w.D. , the 'llilliua l vr1lklns eo..,..ny, Balti..,re, 1943. The proaeu consisted of aotinom;yootio Clb&ocases and slnuseo or the loft -tissues ot the toot and ~ttno~aotio ooteomyoliti• of tho b onoo or the root. Tho patient hod mild 41o.botoo ,..llituo. lie.,.. l&ot aeon fiTo months &ftor tho Llllputatlon, with tho atump of the leg well heeled and no evidence or syateDdo aotino~oosts.
Ko. 12
lladuro'SY"Oiia (Probable m noopori= t.plospor~~~m) Fleur• 46.
CHnioal note: An irre-gular ••• the tite or e. hen's Ot£ W&l received a.t the ~ke Department of Pathology in July, 1940, with tho dia~oaia of "chondroma ot the fitth m.etato.raal bone~ lett toot .'' I t had been ramved !'rom a colored ..., of 57 ye~re. a residont of llorth Cvolinn. Inquiry by letter e. short time~ dter tho operation elicited the inrormation that the operative 11to had ~ ~~ healed oompletely. In Fe.bruory, 1944~ about three and one .. htJ.t yec.rs later~ .. 1J ~-lllOth&r lUll the aaae siz:e we& reooi•od, hflvi.ng been rel:CTtd trom the sa.me OJI' p&tient aDd the le.J:Ie portion or the t oot . No DOra i.D.forma.tion 11 f,.Tailable. It
.,IJ<.. htl:oloc:y: the ,... .. froa the firat 6parat1o11 ia irrecuhr, z>o4ular ODd yell.- ~(# u4 not co•or ·ed rith skin. '!he out aurtt.ce shOW3 white are•• 2 to 3 IlL aoroea llpt.J"tfted by tear t-issue eo~aininc yellow toc1. The mt.as troa the seo:Ond operation ic ah:dlar o;xcept tha~ thero 1a e. strip of skin on tho aurfaoe. ·
---~ Jrvvv. .t ~ \ &orw--Uo. 13
~~__!)~~:?-•!! (torulosis) or mon1ngcs iiiil:~ :lo. S43S, Gr.., obi11.
a.nd brd.in.
lhite :aale or 4-4 yu.rs: S~om~ rotorable to t..~e b r ain and :o-Aninses bega.n 1 !JI)!\t.~ bo.fore death~ in tho foro. or hoaclaohc ar..d dimness or rls:1on~ J..t tutop:sy lations o f cryptococooah were not f ound in the thoracic aDd abdo;d.nd viscera . Grotsly the leptomsningea •Ppe~red about normal. On the cut surfeoe ainuto oyeta~ porhap~ dilatations of the periva-scular spc.ooa , wore noted c.s aeon in the miorosoopic section. Tho organism was grown ln culture.
!!o . 14
Cryptooooooaia of lung. f\lnpa 66.
alte male of 19, Pemtsylve.nle.n, had 'beon A laborer in D.
tF years prior t o rejection by tho o.rmy bcol\use of X-r•y Rl~ht ~neum:>neotomy perfon:~ed 5 months otter re,eotion.
roll1~ alll for finclin~a In che•t. X-ra,s had shown •
p-ad.ually inoroui~ oolitary auo in rigM lower lun&, roailldor of lung tlel.ds Aonu..l 1Jt appeara.noe. No olinioal spptoas. ltine months after operat ion patient perteotly woll. Fun£Us w•e not cultured. Seotlon ot the lower rlcht lobe ab""o4 & firlo greyiob-llhite, hoJDOgeneous < "tWDOr" 3.5 .... i ll 41 ... tor sharply differentiated troa the adjaoent lunt tiosue. A hilar lymph t!OCI.e na no~ croall:y but showed tho f'uncua ercaniau iu .c1e.nt oolla.
t1}tl"'1 J.8 llo . 15
.B.raiD - C!'Jptocoocoa1e . S ld H •44c-31
A 'lh1te lUll •&ed 52, ooapld:aed tor seTera.l <lar- ot aeTere het.d.aohe, ._ then ot diplopia. Thh wu t oUowo4 b y lapoe i!lto oall!l. t.nd death. At o.utopay, the dura. and araoh.llold were t'ouud to be oon.neoted by aoatte:re4. atrinc-like 14.bedona • 'l'he pi,a-ue.eh'DOid waa thickened e.nd hM. a. sowwbat &elatinoua tondstenoy • A tffff 't:i.IJT OY'tie. areaa, 1-2 Jl:l• in dle..eet.r, were fou.nd it11 the outer 'Pe.rtl of tho pe.r1eta\ oerebral cortex.
M~~ ~~1r~~~~· T~ ~;t;:..--t.. ~ .
l!o. 16 ---- . -) •
ea1• of brain.
In t. reoellt port Gregory, J E., C~lden, A. aM Bll.)'!ilAker, v;. {lluconrweosh nenous eyatem. A report ot throe cases . .)ohn.s Hop.id..nl Sull.,
h&Te de•~ribed threto ln.stanooa of brain and menin&eal inteotion to speoies of WUo~r, entering by way or ~he orbit. In the ures exeat identtfioation or tho fungus was not poaGible. The
ot th.e oentr 13:405, 1943) ~roownt.bly du lbaenoe of ouT le.rl • di .,.,ter were features
.Th• sHdo
ot the hyphae, the manner of' branohins and the laok of aeptationa 1oh ouggeoted that the fungus boloJllled to th.e lluooraoeae.
Ome£ f'rom one of theso reported ca.ses.
!lo. 17
ChroMbl~tor:ycosis !!!_ ~· !'lingua 30.
Clinical note: Nodular, werty lea ions h&.d been preaent tor seTera.l yet.ra ~n the dors~~ of the toot or a you~ adult Qpbulatory male. Wide e• oiaion ~ been ~ployed -in tre&t~nt and the aeotion wns prepared from the excised materia.}.
llo, 18
~ - Chro~olaetomrcosi~ - S~bndtted by Dr , Zola Cooper
A •hite l:IBl1, e..ged 39 , a. re..rmcr who had lived continuoudy in ttiasourt, presented hl•elt in Jiey, 1942 nt t he Be.rnud Free Skin and CGllOer Rospital oo~~~p1ainl.ng ot a •sore "' on the r1pt ear . llo waa aasignell to the surgical clinic by- the t4a.ltt1e& officer. 'ihe f'e!lrl.ly hietory was irreleTan·t. Sis ~.&t history '1f8.8
111entially net ative and did not relate to his oo~plaint on Admiaslon. On pnysio&l examination his rewpiratory, eardiovaeoul&r and gastro1nteat1nal eyateml ~ere normal, His present illness hed begun two mont hs boto re, at wh!oh time he notioe4 en er ¥ption on the helix of hio right ear . thi• had slowly 1ncr~c.sed in a1'e .
I!Xe.:JdDAtl,on - Just Inside the hol1x or the right ear there was a a lightly ra1aed uleer atiTe a rel!l ncaa\lrin:g 1 . 5 by 0 . 6 c:m.. There were no pe.lpable nodea tn the neck . 1'he oll.clcc.l di agnotil Wtl.$ squnmo\la coll oe.reinom. An e~cislon ot the entir-e lesion umt -p!L--t of t he e-n.rtil ngc wo.a r ecoii'!Cl0nd64. On June 1~ l94Z a of.\utery exo1e \.or~ of' the l nniou, including n. segment- of tha co.r-tila&e~ na m.c.d. e •
L&bora.tory E:te.::inAtion : T:!le 3':rgicl.:.. S""?t;~\r-en c t)na1atcd ~r t..n ellipse o f akin M-asuring 2.6 by 1 .. ~ en. !.to :h•,ce-t o. no-lu la.r., crusted lesion which an section appe~red to bo woody hard. rhc rracess did no~ i~~olvc tho under lyiD£ o•rtU•se.
~oroaoop1oally, a oeotion of the tttr.~u sho~ed ep1donmal ' hyperpl&11&, extensive hypork.ara.tosl:s , -parakoratiosis O£d &c ll-t:hos-ia "'ith a length~ning ard. distortion ot the rete pegs. !)tteEing; thro~?"'t t~ u p?Cr two thirds ot the den:rl.s na an extensiTe inti•tra.t:e m&.ic "ap t:>t lynphooytoa~ eosiuol_lhUs , polyrorphonucleu leukocytes and rw~.nus t;1ant oells, lD tho ,1&.nt cella and t.lso au.tte i'ed throu,hout th• ini"il".;!'s.t:o \'fOre l1Ult\ef'CU& brown, thicJc walled orgalrlsu. In SoQS ~of the orsanlsu:;;s cro::.s w1.11a could be r.oen. These wore the cha...raoteril• tio organism., ot ohro!'XIm:tc<Jsis .
No . 1~
Cocoidioidomyooaia of ~· Fungus 9.
Cell S ot Ct.ldwell, G. T .~ 'Texa-s State Journl\l or 1Led1c1ne, 38, S76, 19(-2 .. 1\hlte t'&.n~er ot 31 yeara, f'exan, 'besa.n haTi.ng pain 1n lett hip one year before docth . At autopsy e. :ooa.aain abscess occupied the- reston ot the lett hip with exten sion to the retroper itoneal region. and down the lert leg. There ~~6 d~•t~ction of th~ hip joint •urtaces. There were bilateral miliary coooidioido.l gr e.nuloJ:M. or the lun&s ~. su.ppo.s odly hematogenous in or1&1n from. the h1p. No large pulroonnry les ione are. described, but the plwro.l co.viti ea were obliterated by ribrous adhoaiona . Endosporulctlon was f ound 1n the spherules- af' tho milh.ry pul-moery lesions.
~1~;:~1 llo . 20 ~~ M
~ - COcc!d!oidomycosia C11 tJ!f. \J, 1 No data a7ailabl~c~·~------_:l_::~::;~~~~:_~~=-E:~~~~~~~~~s.-..-.-.-J.
Coo_oidtaidOl!fOO~ _?l: t~ · ?u~t; 80.
Clinical Jfote, A-negro role of as years developed a cough o n S/l/4S1 tour ulonths betore his &cat~ Re ent erod a hoB pi tal in Aritona. on 4/'5/43·. On 4/10/43 the- aupro.pla~i~ular ly:tonh nodes beerune painf'.ll al".d swo1leu. reaohing the s i ze of a small ora g.n£ . 'fh~Ge wer.e ino! . .s'oa and c . im:nitis was domonsttated in diFeet srnea.rs of lUE=' 1\nd !.-n oul~e. The s putUm ilso oontJ.dned th~ fungus. He lost weig_ht , rai:t a septic tempel'ature ~ncl had evi:dttnca of ue.rdiac failure in the form of dyapn ea and depend~nt ede£ll\ not long_ Oefqre he di ed . He was anemic (_R.B .• C. 2.e ll) ahl h:id a lculo:>oytosis (W.B.C. 16, 350),
Sterile l;>lood wes sent to ~tanford Un1c<'ers1ty on -./22/45 and the report read, "Find<ings 1ridio"ted a very severe t>r i,.....y oooeidioidal infection. In tact, complement fixation tite~ is in range seen in disseminated inteotion."
X-r~y on admission shol¥cd what wa.s intArpreted c.s enlargemnt or the t -raoheobronohial lymp.i. n::~des r and e. lt>&it\h oi the le~ l ul){; extended £r.Qtil the hilum to the periphe ry ·,etwoen tn(! 1E1ye1 s ot• t he see:Qnd and .fo.ur:th ribs -posteriorly;. ~o.tt).cd, d isercto foci c-f <.a1eifi oa t i on ·v~Ure rtoted in the lO'i'ter C'errtco.l region e.M, Wl3r -<!t th-~uE;"-tt +.o l ie -wH:h l n 1 ,rill~!h !'.Odes.. Death. ooourred 7/3/43; - ~
'Pe.tllo~egy: Gros·aly there were no l arge arell.s n-f' consolidation in the lungs , but there were tubercl es of ~liary {pin-hend) size in the lungs, liTer-ep~e~n and kidneys. 1!h:ere· w~s c:hron:.c f'ibr<J.S i:.ng pericarditis and o.atoomyelitia of the ribs. nte· mediast.i:nnl and pare.-aort'io lymph npdee were enla;"£ed conUinil'fg abGoes&es a.nd oe.1reous _f oci. An a.Qsces:s- :t.ay b-ot7feen the tail of the pancr eAs and the stomaoh . F'ivc crusted leaion~ , es.Oh with an ATero.ge diameter ~t $ mm. , ooou:rred on the cheeks o.nd chin. Tnere W&.S a gaping draining wound 2.5 om. long just above each clavicle. ?he liver wac twioe normal weisht ~md thQ: spleen w~ six times normal weight .
Fungu• 88 •
. ?issue from oase ib Bre.til .
llo . 23
lrorth Atn.er.ioe.n. ble.stomycosia--pneumon~o:tomy • . Fungus 56.
'llhite woman of 36 was thought to he.ve oar.oinoma of lung a.tid lung was !""amov&d surgical ly. Grossly there was -0. la.rge, fist-si~ed, oircumsoribed, grayish \dtite ~.ss in the right lung without cavities . ·seotion is from this mass . !ha patient- r ecovered trom the operation but som& !:lOnths l ater- developed a. lesiop in -the dor.so.l. spine diagnosed blo.s:tomyc.o&is by biopS1)"•
Cutaneous North #.l!lerice.n bh.•tomy""~· ~ 27.
Cl1nioa.l Note: l'fhite lYle o f 7 1 j·ea..rs. ten oonths betoro the oxchion of the ti&l\le 1. minute Teddoned nednlo developed on the lett wrist. t his sof'tened , uloor1.te<l,. and led to the J'Ot"li\a:~1on of en ulcer which encircled tho Yn"iet e.nd axtelldod 6 om.. up the l'll'm. t h e loaion we...s t r c:a.ted by dtsen.aitir.a.tion of tho pationt nth anti~en ct B. dermatitidia e.nd by iodide thorapy by ,.,ut h od by X-ro.y·•. Since ccoplot'u holillng we.s not seoured,l!IUoh or tho lesion wa1 cxoieed. U&terlal from \~is excloion w~s used to pro~ro tho aeotion deaor ibed below. the patie:rt ~ ~:r.bulatory, e.f'obrilo, and showed no teatu.rea of the SJSt·ellio type of blastocryeoeit.
Autopay #J.~l7 II
No . 25
ODAet or skin lesion 5 yoa..ra atO laid to be due to lnteotod leAther in show factory. Onset ct 1D1t1&1 leaicn on "boil" ct ahould•r (lett ) . Dia&nosod bh.ato:;yooail 3 yee.ra qo. CUta.noo\11 apre-at! . - ODe and a. he.lf ye&rs a,;~ p&tleat betan to h~Te pulmon.ry e~aa. Patient also de•elopod anem&a. 0!! en~ra.noo here patient had lollona ot tkl-n. 1Ul1&s, bladder, prostate, bones ot left toot , possible iritis. Skin lesions of lett shoulder, face, l eft arm, holt, .,left feet, PatieJlt had COI.I&b nth yellow oputuJ:t (cooalional blood), Dyspnoa incr eased ao p~tient requ ~red oxygen co~stantly. Pationt was in Firmi~ Desloge Hospital 4 -18 t o 7,11, 1942 ~ ~-11 to 2-9, 1943. Reeeived Roontgon t herapy. Weight l o BI 65 pounds plus in 1 t years . Frequency of ur:lno.'~ion, dyeurin., hematuria . llo retention. History o£ TBo in fathCr .
!llood from i nter i or vena. cava - Eaohoriohi a aol1 and Staphylococcus ll.ureua • raba from the lung a.nd tho proatate - Zymone~ de,.,..tit1dis o.nd
Staphylococcus a.u;oua
Autopay Observations :
Blutoayoosis involTlll& the a kin, lu.n.gs, kidneys , pr oat ato, urinary bladder • . nnd odronal eland~ .
Seotiont.i : Adrenal
No . 26 rvf, ~.fcwr :--
llbn111a.s1.a of e sophagus. dtJN'Y.I ~ llo data uaiTable. _ _ ___ .,.._ . ~· ~~··
MAL·
lil'$-~~ No . 27
Exp~rimental sconotriaholit. ~ouse.
"BX"perb::lental Data.: W.ce were inoot:~a.~rd. intrnr-::r it.oncar .y vlit't a auopo!lSi?n of s. s chenckit whioh had been gzown on Snb~ura~d ' 3 g~uoJs e agnr. this suapenlton contained hyph~e aa wel\ e' o~l co~id1a. !o c~tnin tbe catorial in tUde 20 t he mouse l<&S killed at ~· end vf 20 de.ya.
htholoc:r: Grayi.sh yellow t!O~U- ra <'Oct•rJ""'ld on the perl.tonec.l eurtaoea aM between the spleen acd livc.r. !'ll. 't!.e l iver ";'fore i ·mu.-uernble mi:tute yollowbh toot. Tho lunga appen~cd ro ~~1 .
llo. 28
Poaa l~le aarerelllosia of 1~•· Fungus 7S.
?ul1:10n>.ry ar-q>tol!lS t or ;st 4yopnea. Tubwou:Un negat ~1&\lo~ lat el" Aa l l u s iBteriil oxpeotora:tca t
•
\
et.ra betoro dee.th With oouch, wei.pt lota &nd ... . CUlt=ea of ' sputum gnw d tlret PenioilUWD n;;er. La.rco q\ll.nt itioe ot thtClc g reen pw;ilent
SeTeral months befor e death •
