PMC10352806_01
Chest computed tomography imaging results of the patient. (A) The chest CT before anti-tuberculosis treatment. (B) The chest CT before anti-Talaromyces marneffei treatment. Chest CT scans showed scattered patches, nodules, and ground-glass shadows in the left upper lobe with ill-defined borders and thickening of some interlobular septa. (C) The chest CT after 2 weeks of cumulative treatment with amphotericin B. The lesions in the left upper lobe of the lung were absorbed after two weeks of treatment with amphotericin B. (D) Chest CT scans of the local hospital after discharging from hospital 5 months. The lesions in the left upper lobe of the lung had been absorbed furthermore. (E). The MRI of spine showed the lesions of thoracic vertebra. (F). The MRI of spine showed the lesions of thoracic vertebra were absorbed after anti-fungal treatment.
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Considering her symptoms and the imaging features (Figure 1A) observed in her chest CT, she was prescribed anti-tuberculosis treatment comprising isoniazid, rifampicin, pyrazinamide, and ethambutol on December 15, 2021. Chest CT scans showed scattered patches, nodules, and ground-glass shadows in the left upper lobe with ill-defined borders and thickening of some interlobular septa (Figure 1B). T. marneffei, 435 reads of Human gamma herpesvirus 4 (EBV), no other bacteria and parasite had been detected. The MRI of spine showed the lesions of thoracic vertebra (Figure 1E). Thoracic cone biopsy was also performed to identify any thoracic vertebral lesions. mNGS of bone tissue revealed no pathogens. Chest CT scans showed that the lesions in the left upper lobe of the lung had been absorbed after 2 weeks of cumulative treatment with amphotericin B (Figure 1C). The MRI of spine showed the lesions of thoracic vertebra were absorbed (Figure 1F). Five months after discharge, there was no recurrence, which was confirmed via a telephonic follow-up, and Chest CT scans of the local hospital showed that the lesions in the left upper lobe of the lung had been absorbed furthermore (Figure 1D).
Positron emission tomography/X-ray computed tomography imaging results of the patient. (A) Thoracic (T-6) vertebral body showing low metabolism. (B) Left upper lobe of the lung showing high metabolism. (C) Osteolytic damage found in the vertebrae.
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Meanwhile, her condition deteriorated, and she started experiencing chest and back pain. 2-deoxy-2-[fluorine-18] fluoro-D-glucose positron emission tomography/X-ray computed tomography (18F-FDG PET/CT) indicated that the thoracic (T-6) vertebral body showed low metabolism (Figure 2A), and the left upper lobe of the lung indicated high metabolism (Figure 2B). Chest CT scans showed some osteolytic damage in the vertebrae (Figure 2C).
Specific stains of lung tissues. (A). Hexamine silver staining of lung tissues was positive suspiciously; (B). Periodic acid-Schiff (PAS) of lung tissues was positive suspiciously.
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(A)
T. marneffei coverage map. The identified reads were mapped to the T. marneffei reference genome (GenBank accession no. MN700106.1). The abscissa is the genome position of the T. marneffei reference genome. The left-side scale shows the number of matched mNGS sequences in the alignment. The right-side scale shows the sequencing depth (i.e., the number of times the base pair site has been sequenced). The blue bars show the number of matched mNGS sequences corresponding to various positions in the genome of the fungus. The red line represents the average sequence depth distribution at different positions in the fungal genome. The yellow line represents the median sequence depth distribution at different positions in the fungal genome. M, position in the genome in millions of base pairs (x-axis scale); (B) The OD of anti-IFN-gamma-autoantibodies of this patient.
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MN700106.1, coverage 97%, identity 99.23%) (Figure 4A). ELISA confirmed that the patient had a high titer of anti-IFN-gamma autoantibodies (1:2500), the value of optical density (OD) was 1.149, which was much higher than negative control (Figure 4B).
Timeline of the patient with relevant data on the episodes and interventions.
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A timeline of the patient with relevant data on the episodes and interventions is presented in Figure 5.