PMC10202698_01
Chest CT image. The township hospital chest CT (A) lung window and (B) longitudinal window shows the left lower lung showed a mass of high-density shadow with vague edge, adjacent to the pleural retraction, and slightly dilated bronchioles in it. The admission chest CT (C) lung window and (D) longitudinal window shows the left lower lung showed a mass of high-density shadow with vague edge, adjacent to the pleural retraction, and slightly dilated bronchioles in it. The discharged chest CT (E) lung window and (F) longitudinal window shows the left lower lung showed stripped-like, patchy high-density shadow with clear boundary, adjacent to the pleural stretch, slightly dilated bronchioles, and more anterior absorption of the lesion.
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CT showed increased translucency of both lungs, scattered patchy and lamellar increased density shadows in both lungs and clump-like high-density shadows with unclear boundaries in the lower lobe of the left lung (Figure 1).
PMC10202698_02
PMC10202698_03
Chest CT image. The township hospital chest CT (A) lung window and (B) longitudinal window shows the left lower lung showed a mass of high-density shadow with vague edge, adjacent to the pleural retraction, and slightly dilated bronchioles in it. The admission chest CT (C) lung window and (D) longitudinal window shows the left lower lung showed a mass of high-density shadow with vague edge, adjacent to the pleural retraction, and slightly dilated bronchioles in it. The discharged chest CT (E) lung window and (F) longitudinal window shows the left lower lung showed stripped-like, patchy high-density shadow with clear boundary, adjacent to the pleural stretch, slightly dilated bronchioles, and more anterior absorption of the lesion.
IDR-16-3101-g0001.jpg
PMC10202698_03_IDR-16-3101-g0001.jpg
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CT showed increased translucency of both lungs, scattered patchy and lamellar increased density shadows in both lungs and clump-like high-density shadows with unclear boundaries in the lower lobe of the left lung (Figure 1).
PMC10202698_04
(A) Colony morphology of Actinomadura geliboluensis after 3 days of culture on Columbia blood plate medium (ultra-micrograph with 4x magnification); (B) weak acid-fast staining (with 2000x magnification) of Actinomadura geliboluensis colonies after slide blotting; (C) Gram staining (with 1000x magnification) of growth in liquid medium of Actinomadura geliboluensis.
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The colony morphology is shown in the ultra micrography (Figure 2A). Acid-fast staining and modified weakly acid-fast staining were negative (Figure 2B). The original liquid culture tubes were kept at 37 C for several days, and flocculent growth and radial arrangement of the filament-like mycobacteria were observed on smear staining (Figure 2C).
Protein fingerprints detected by MALDI TOF.
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TOF, the direct method and the formic acid extraction method were used to identify the mass spectrometer, and the obvious peak shape was observed, but the identification results were unreliable. The identification positions suggested semi-green and semi-red, and the protein fingerprints are shown in (Figure 3). 
PMC10202698_05
The timeline shows the entire diagnosis and treatment process of this case.
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The timeline of patient diagnosis and treatment has been shown in Figure 4.