Presentation
The patient presented with productive cough and fever with chills and rigor two weeks after a renal transplant for rapidly progressive glomlerulonephritis.
Patient Data
HRCT images (axial and coronal views) show multiple pulmonary nodules of various sizes with surrounding ground-glass opacity in bilateral lung fields.
Microscopic examination of the sputum and bronchoalveolar lavage (BAL) under methaneamine silver stain showed fungal hyphae and fruiting body consistent with aspergillosis.
Case Discussion
Halo sign is the radiologic appearance of a pulmonary nodule or mass surrounded by a ground-glass opacity (which indicates angioinvasion). By itself, the sign is non-specific and may be seen in a wide variety of conditions, including but not limited to, infections (mostly fungal but also viral and mycobacterial), primary lung cancers (such as bronchioalveolar carcinoma), and lung metastases.
In the present case, the patient was neutropenic due to the use of immunosuppressive drugs post renal-transplant and thus susceptible to infection by Aspergillus.
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