A Mediastinal Mass Resembling Lymphoma: An Unusual Manifestation of Probable Case of Invasive Zygomycosis in an Immunocompetent Child
Thanyawee Puthanakit, MD*, Yupada Pongprot, MD*, Thirasak Borisuthipandit, MD*, Pannee Visrutaratna, MD**, Suphachai Chuaratanaphong, MD***, Neelaya Sukhamwang, MD****, Kamthorn Thamprasert, MD****
Affiliation : * Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai ** Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai *** Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai **** Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai
A 2-year-old girl presented with prolonged fever and progressive dyspnea for 3 weeks. A chest
radiograph revealed a left lung infiltrate and associated pleural effusion. Echocardiography revealed a large
posterior mediastinal mass extending to the left atrial wall and massive pericardial effusion. The presumptive
diagnosis was lymphoma. At operation, a large brownish-yellow mass was noted at the posterior mediasti-
num, with matted hilar, and subcarinal lymph nodes. Pericardial and pleural effusions with left lung consoli-
dation were also noted. Histopathological examination of biopsy specimens revealed a granulomatous
inflammatory reaction with a diffuse eosinophilic infiltrate and broad septated fungal hyphae with right
angle branching compatible with zygomycosis.
Surgical removal of the mass could not be performed due to the adjacent great vessels and carina. She
subsequently died from airway obstruction and respiratory failure ten days later.
Keywords : Mediastinal mass, Pericardial effusion, Zygomycosis
