PMC6444252_01
Chest X-ray. (a) Thickening of bronchial walls with no concomitant parenchymal abnormalities. (b) Multiple ill-defined lung nodules (arrows). Enlargement of the cardiac silhouette and left pleural fluid.
CRIRA2019-5395090.001.jpg
PMC6444252_01_CRIRA2019-5395090.001.jpg
fig1
Chest X-ray evidenced thickening of the bronchial walls with no concomitant parenchymal abnormalities (Figure 1(a)) and urinalysis showed an increase in white blood cells and few Gram-negative bacteria. The computerized tomography (CT) of the abdomen and pelvis was normal but a follow-up chest X-ray evidenced multiple bilateral nodular lesions and left pleural effusion (Figure 1(b)) and positive blood and urine cultures yielding K. pneumoniae sensitive to penicillin, quinolone, and carbapenem.
US Testicular Doppler. Hypoechoic collection of 0.7 cm3 with debris in its interior (arrow) located in the tail of the left epididymis associated with an increase in volume and vascularization of the epididymis (blue and red signal).
CRIRA2019-5395090.002.jpg
PMC6444252_01_CRIRA2019-5395090.002.jpg
fig2
The testicular ultrasound showed an abscess in the tail of the left epididymis (Figure 2); oral doxycycline therapy was administrated.
Chest CT scan. (a) Consolidations with peripheral ground-glass opacities compatible with halo sign in the apical segments of the upper lobes (white arrow). (b) Nodule with central ground-glass density and consolidation ring (reversed halo sign) in the apical segment of the upper lobes (black arrow). (c) Coronal reconstruction. Multiple peripheral nodules, some of them with reversed halo sign (black arrow) and halo sign (white arrow).
CRIRA2019-5395090.003.jpg
PMC6444252_01_CRIRA2019-5395090.003.jpg
fig3
The CT of the chest confirmed the presence of multiple bilateral nodules with halo sign and reversed halo sign (Figure 3).
Chest X-ray. (a) There are no consolidations in the lung parenchyma or pleural effusion. US Testicular Doppler. (b) Testicle and left epididymis of normal size and vascularization.
CRIRA2019-5395090.004.jpg
PMC6444252_01_CRIRA2019-5395090.004.jpg
fig4
Clinical evolution after a 14-day antibiotic course was satisfactory with an improvement of the respiratory symptoms and marked decrease in pain and testicular edema, the chest X-ray at day 14th showed a disappearance of the consolidations, and the testicular ultrasound of follow-up at day 16th showed a decrease in local inflammatory signs and resolution of the abscess in the tail of the epididymis (Figure 4).