Fig. 5

Histological findings on autopsy. a In lymph nodes, infiltration of CD38+ plasma cells was observed in the intrafollicular space (immunohistochemical staining of CD38). However, the number of plasma cells is decreased compared with that before treatment (Fig. 1f). b Double contour of the glomerular basement membrane with mild mesangiolysis is observed in the glomeruli (periodic acid-methenamine silver staining). c Subendothelial swelling is observed (electron microscopy). d Macroscopic appearance of a cross section of the heart revealed necrotic areas with dark reddish-brown color, corresponding to the anterior wall and septum. Left ventricle walls were thickened, and cardiac hypertrophy was observed (weight, 460 g). e Calcification is observed most remarkably in myocardial cells. Some of the myocardial cells are replaced by calcified tissue, and the remaining myocardial cells are intact (hematoxylin and eosin [H&E] staining). f Calcification is also observed in the skeletal muscle cells of the diaphragm (H&E staining). g In the right lung, fungal hyphae are abundant (Grocott staining). h In the lungs, intravascular invasion by fungal hyphae is observed (H&E staining). i Intra-alveolar invasion by fungal hyphae is observed (H&E staining). j Enlarged cells with intra-nuclear inclusion are remarkably observed in the lungs (H&E staining). k These cells are positive for cytomegalovirus (CMV) infection (immunohistochemical staining of CMV). l Subcutaneous tissue of the anterior mediastinum shows that fat tissue is largely replaced by fibrotic tissue. No infiltration of inflammatory cells is observed, and no remarkable finding in tissue of the thymus is noted (H&E staining)