PMC9353032_01
Pre- and post-therapy CT scan. (a) Chest CT before treatment. (b) Chest CT after cefotaxime sodium sulbactam treatment. (c) Chest CT after voriconazole treatment.
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F1
On 13 November 2020, a chest plain scan and enhanced CT showed left lower lobe and right pulmonary cavities lesions (Figure 1a), which suggested possible pyogenic inflammation, fungal infection, or secondary tuberculosis. After 10 days of regular treatment, the chest CT scan showed little change compared with pre-treatment (Figure 1b). On 29 June 2021, a chest CT was performed and showed a progressive decrease in lesions of the patient (Figure 1c).
Bronchoscopic image on November 17th (left) and 20th (right), 2020.
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F2
On 17 November 2020, a bronchoscopic examination showed that the bronchial mucosa of each lobe and subsegment on both sides was congestive and edematous (Figure 2).
The Cryptococcus neoformans mNGS and culture result. (a) The mNGS result of C. neoformans. 0.01% of bacterial reads corresponded to C. neoformans with a coverage of 0.0004%. (b) The results of the fungi smear showed C. neoformans.
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F3
On 21 November 2020, the mNGS result came back and showed one specific read of C. neoformans (Figure 3a). On 23 November 2020, CrAg-LFA (titer 1:80) and fungal culture (creamy mucoid colonies with relatively smooth edges on Sabouraud Dextrose Agar medium, initially colorless and which appeared lavender with time after staining using CHRMagaar color plate) revealed as positive, confirming the mNGS detection (Figure 3b).
Timeline of the reported case.
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F4
The whole treatment process was shown in Figure 4.