PMC7423344_01
The chest CT showed nodules and patches in the upper lobe of the left lung on admission (A); enlarged lesions in the upper lobe of both lungs and bilateral pleural effusions were observed on the 13th day after admission (B); bilateral infiltrates, interstitial infiltrates, alveolar infiltrates and bilateral pleural effusion were observed on the 20th day after admission (C).
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The chest CT showed pneumonia in both lungs (Figure 1A). A repeat chest CT also showed further infection in both lungs compared with that at admission (Figure 1B). The patient began to defervesce but the repeat chest CT also showed further infection in both lungs (Figure 1C).
Yeast forms of Penicillium janthinellum in BAL washings stained with fluorescence (A, Original magnification X 400), Gram stains (B, Original magnification X 1000), hexamine silver (C, Original magnification X 400) and fungal morphology stained with medan lactate (D, Original magnification X 400). Colony morphology in the obverse side was cultured in 28  C PDA medium for 5 days (E) and Colony morphology in the reverse side (F) was cultured in 28  C PDA medium for 14 days.
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BAL fluid. BAL fluid stained with Gram, fluorescence and hexamine silver stains showed the presence of somewhat dichotomously branching septate fungal hyphae (Figure 2A-C). The conidia were spherical or elliptic (3-6 mum in diameter) (Figure 2D). The organism had white-coloured villiform and produced a slight yellow pigment on the reverse side, showing that had the most pronounced growth at 5 days on potato dextrose agar (Figure 2E). Notably, the organism developed a purple pigment on the reverse side after 14 days of growth on potato dextrose agar (Figure 2F).