PMC9127990_01
(A) Pulmonary CT on December 5, 2018; (B) Pulmonary CT on January 22, 2019; (C) Pulmonary CT on April 23, 2019; (D) MRI of the brain on December 22, 2018; (E) MRI of the brain on January 17, 2019; (F) MRI of the brain on May 24, 2019; (G) the rash on the patient's head; (H) The rash on the patient's body.
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F1
The patient was admitted right in the middle of the fever break, and his admission examination showed a body temperature of 36.3 C, respiration at 20 times/min, pulse 92 beats/min, pulmonary CT: multiple nodular shadows or lamellar shadows in the left lung, new appearance of multiple lymph nodes in bilateral axilla and mediastinum, and partial lymph node swelling, as shown in Figure 1A. Multiple reddish plaque and nodules were scattered over the trunk and limbs, with tenderness, and some erythematous pustules were observed, as shown in Figures 1G,H. MRI revealed the presence of a brain abscess and multiple nodular shadows as shown in Figure 1D, and the patient's fever peaked at 40 C. Multiple microbial cultures of the blood, phlegm, and pus were negative and the lung CT showed absorption of the lesions Figure 1B, MRI showed an increased presence of the multiple nodular shadows as shown in Figure 1E. Follow-up lung CT Figure 1C and brain MRI Figure 1F showed that the lesions had improved significantly.
(A) Direct blood culture smear by Wright-giemsa staining (x1,000); (B) Direct blood culture smear by Gram staining (x1,000); (C) Nocardia vulneris by Gram staining; (D) Nocardia vulneris by weak acid fast staining; (E) Colonies of Nocardia vulneris cultured for 3 days; (F) Colonies of Nocardia vulneris cultured for 15 days.
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F2
Gram-positive long thin filamentous bacterial group was found in the smear, as shown in Figures 2A,B. Large, dry, white colonies with obvious smell of dust, which did not embed into the agar, was observed after 72 h Figures 2E,F. Meanwhile, long filamentous Gram-positive bacterial group was found in sputum samples and scalp pus, and the weak acid-fast staining was positive, as shown in Figures 2C,D.