Most frequent gross and histopathological features of acute fatal Exserohilum meningitis. A: Hemorrhage around base of brain. B: Cerebral artery
thrombus (arrow), as part of the circle of Willis. C: Expansion of meninges by necrosuppurative infiltrate and vascular thrombosis (arrowheads). The asterisk indicates
brain parenchyma. D: Infiltration of a large meningeal arterial wall by neutrophils. E: Infiltration and destruction of the middle cerebral arterial wall by neutrophils
(inset) and a large luminal thrombus. F: Fungal elements (arrowheads) admixed with the mural inflammatory infiltrate, higher magnification of same section as E. G:
GMS stain highlights numerous fungal hyphae within a large arterial wall. H: Polyfungal IHC shows many fungi unaccompanied by inflammation in the tunica media of
a large cerebral artery. H&E staining (CeF); GMS staining (G); polyfungal immunoalkaline phosphatase staining, naphthol fast red substrate with hematoxylin
counterstain (H). Original magnification:6.75 (C); 12.5 (D and G); 12.5 (E); 158 (E, inset); 25 (F); 50 (H). Scale bars: 10 mm (E); 100 mm (G); 40 mm (H).