PMC10423897_01
Imaging and pathological diagnosis. Brain magnetic resonance imaging (high signal on the T2 weighted images) shows multiple nodules in bilateral cerebral hemispheres (A), right cerebellar hemispheres (B), pons (C), and medulla oblongata (D). Histopathology demonstrates spores of Trachipleistophora hominis in sections of gastrocnemius muscle stained with Gomori methenamine silver (E) and fungal fluorescence staining (F). Lesions and pathogens were marked by arrows. Pathological images are shown at x400 magnification. Bar=20 mum. The distribution of fungal, bacterial and viral sequences identified in the patient's Gastrocnemius (G) and Cerebrospinal fluid (H). The name of the fungi and viruses are marked in red and blue, respectively.
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Cerebral magnetic resonance imaging (MRI) revealed multiple parenchymal lesions with fine contrast enhancement in bilateral cerebral hemispheres, pons, medulla oblongata, and right cerebellar hemispheres, most of which are located in bilateral cerebral cortex (the large one can reach 15 mm in diameter) ( Figures 1A-D ). Several scattered oval-shaped pathogens were observed by Gomori methenamine silver staining ( Figure 1E ) and fungal fluorescence staining ( Figure 1F ). Within 24 hours after receipt of the samples, 3 species of fungi, 6 species of bacteria, and 1 species of virus were detected in the gastrocnemius tissue ( Figure 1G ). Meanwhile, 1 species of fungi and 3 species of viruses were detected in cerebrospinal fluid sample ( Figure 1H ). T. hominis infection was confirmed, he initiated a 12-week course of oral albendazole (800 mg/d), a 5-day course of oral dexamethasone (5 mg/d), and regular antiretroviral therapy (Biktarvy). The patient was discharged after 6 weeks of treatment, when the myalgia was significantly relived, and the size and degree of brain lesions were improved ( Figure S1 ).
The timeline of disease progression and treatment of the patients.
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Hominis ( Figure 2 ).