PMC7268139_01
(A) Past chest CT scan (1 January 2019) showing multiple disseminated ground glass opacities with multiple bullae. (B, C) Chest CT scan during follow up (26 January 2019 and 27 April 2019, respectively) showing distinct resolution of both lungs.. CT, computed tomography.
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A chest computed tomography (CT) scan (1 January 2019, Figure 1A) showed multiple ground glass opacities with multiple bullae in both lungs. The CT scan showed multiple disseminated ground glass opacities with multiple bullae in both lungs (Figure 1A), no pleural effusion and pleural thickening, and no swollen superficial lymph nodes throughout the body, and no abnormal echocardiography, abdominal B-ultrasonic, and brain CT were observed. Two repeated chest CT, on 26 January 2019 (Figure 1B) and 27 April 2019 (Figure 1C), revealed distinct resolution of both lungs.
Bronchoscopy showed local uneven membrane surface (A), hypoechoic areas in group 7, 4R, and 11Rs mediastinal lymph nodes through CP-EBUS (B), and hypoechoic shadow in the dorsal segment of the right lower lobe through RP-EBUS (C).. CP-EBUS, convex-probe endobronchial ultrasound; RP-EBUS, radial-probe endobronchial ultrasound.
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Bronchoscopic examinations revealed uneven local membrane surface (Figure 2A), hypoechoic areas in group 7, 4R, and 11Rs mediastinal lymph nodes through convex-probe endobronchial ultrasound (Figure 2B), and hypoechoic shadow in the dorsal segment of the right lower lobe (RLL) through radial-probe endobronchial ultrasound (Figure 2C).
Culture of BALF revealed Talaromyces marneffei, which shows temperature-dependent dimorphic character, growing as yeast-like cells at 37 C (A) and as a mycelium at temperatures between 25 C and 30 C (B); the cells produced red pigment at 25 C (C).. BALF, bronchoalveolar lavage fluid.
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BALF and the biopsied tissue mass also showed the existence of T. marneffei. Based on the pathogen's temperature-dependent dimorphic growth characteristic and the production of soluble red pigment and PAS-negative cell content, the isolate was identified definitively as T. marneffei (Figure 3A-B).
(A) Family map and Sanger sequencing. (B) Illustration of the functional structure of STAT3: p.R31Q in red and other known pathogenic, or likely pathogenic mutations, in black. (C) The labeling of p.R31Q on the structure of STAT3 modeled by the I-TASSER algorithm.. STAT3, signal transducer and activator of transcription 3.
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A blood gene detection test was taken, which indicated a loss-of-function mutation in the gene STAT3; however, there were no similar mutations in her parents (Table 2, Figure 4A).