At necropsy, a large 1-x-2-cm ulcer was present on the dorsal surface of the tongue, and ulcers were present on the hard palate.
Histologic examination of the tongue revealed chronic, focal ulceration. The surgical site on the lesser curvature of the
stomach was intact. Histologic examination of the area immediately surrounding the suture line showed that it contained neutrophils,
lymphocytes, and macrophages. Scattered, perivascular infiltrates of lymphocytes and plasma cells were present in adjacent
gastric mucosa, which is consistent with gastritis. Petechiae were observed on the serosal surface of the jejunum, and melena
was present within the lumen.
Figure 2B: An abdominal radiograph showing a large volume of free gas within the peritoneal space, enhancing the visibility
of the serosal surfaces of the abdominal organs.
The lungs contained multiple firm nodules. Pulmonary histologic findings included a severe, multifocal, subacute to chronic
bronchopneumonia with bronchiectasis and a more acute necrotizing bronchitis. The pneumonia was characterized by interstitial
lymphocytic infiltrates and fibrosis. Lymphocytic infiltrates and fibrosis were also observed on histologic examination of
Infectious agents, including T. gondii, were not evident in sections stained with hematoxylin-eosin or Gram's stain, and modified Steiner silver stain failed to
reveal Bartonella species in any of the necropsy samples. However, Gomori's methenamine silver stain revealed fungal organisms in many tissue
samples. In most locations, fungi were yeast forms up to about 8 µm in diameter with narrow-based budding, but septate hyphae
were also present in the bronchial debris along with budding yeast. Yeast organisms were almost always found in areas of inflammation,
including the liver, alveolar parenchyma of the lung, and both eyes, and were particularly numerous in the adrenal medulla.
Rare hyphae and yeast were present in superficial and deep sections of the tongue.
Figure 3: The gastric perforation intraoperatively.
The morphology of the fungi in sections stained with Gomori's methenamine silver was most consistent with Candida species (Figure 4), and identification was confirmed by the results of a germ tube test performed at The University of Tennessee College of
Veterinary Medicine Clinical Bacteriology/Mycology Laboratory. The germ tube test is a simple, rapid procedure that is used
for the presumptive identification of Candida albicans.1 The test was performed by inoculating colonies into a tube containing 0.5 ml sterile horse serum (GIBCO cell culture products—Invitrogen,
Carlsbad, Calif.) and incubating the tube at 98.6 F (37 C) up to four hours. The incubated material was examined under a microscope
for germ tubes or true hyphae, which must be distinguished from pseudohyphae. Candida albicans was demonstrated in necropsy samples of the spleen, liver, alveolar spaces and bronchi of the lung, interstitium of the kidney,
adrenal medulla, posterior chambers of both eyes, bone marrow, and mesenteric lymph nodes. Organisms were not identified in
the brain, another organ affected in patients with disseminated candidiasis.2,3