PMC9330379_01
(A) The patient's initial chest CT examination results when she visited Zhongshan Hospital affiliated to Xiamen University on December 13, 2019, after 1 week of fever. (B) The repeat chest CT at Zhongshan Hospital affiliated to Xiamen University on December 16, 2019, after the patient's dyspnea worsened. White arrows indicate multiple patchy blurred shadows in bilateral lungs, which had progressed compared to initial examination.
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F1
She had visited Zhongshan hospital affiliated to Xiamen university where she received oseltamivir, imipenem and cilastatin for 4 days due to leukopenia (WBC 1.44 x 109/L) and patchy shadows on lung CT (Figure 1A), and was referred to our hospital due to progressive multiple patchy haze in bilateral lungs (Figure 1B) and dyspnea.
Repeat chest and abdominal CT on December 19, 2019. (A) indicates pleural effusion (black arrows). (B) indicates patchy blurring (black arrows). (C) indicates the enlarged liver (white k arrows). (D) indicates pelvic effusion (white k arrows).
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F2
Computed tomography showed multiple patchy shadows and consolidation in the dorsal region of bilateral lungs, as well as moderate pleural effusion (Figures 2A,B), enlarged liver and spleen, and moderate effusion in the abdominal cavity (Figures 2C,D).
Whole body PCT-CT examination on January 8, 2020. (A) indicates hyper-metabolic lesions (white arrows) in the liver. (B) indicates hyper-metabolic lesions (white arrows) in the lungs. (C) indicates hyper-metabolic lesions (white arrows) in the femur.
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F3
The results showed multiple nodular hyper-metabolic foci in the liver and lungs, slightly increased metabolism including bone marrow (Figures 3A-C).
(A) Indicates irregular hyper-enhancement in the arterial phase of the lesion, with a transient abnormal enhancement area (white arrow) in the center. (B) shows the abnormal enhancement area in the delayed phase with low enhancement (white arrow) in contrast-enhanced ultrasound.
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F4
Subsequently, the patient underwent a contrast-enhanced ultrasound biopsy of the upper border of the right lobe of the liver (Figures 4A,B). Figure 4A shows irregular hyper-enhancement in the arterial phase of the lesion, with a transient abnormal enhancement area (white arrow) in the middle. Figure 4B shows the abnormal enhancement area in the delayed phase with low enhancement in contrast-enhanced ultrasound.
(A) Histopathological examination indicates fusion granulomas with caseous necrosis in the liver tissue (black arrow). (B) histopathological examination indicates Langhans giant cells in the liver tissue (black arrow). (C) acid-fast staining shows mycobacterial accumulation in the cytoplasm (white arrow).
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F5
The histopathological examination showed Langhans giant cells and fusion granulomas with caseous necrosis in the liver tissue (Figures 5A,B). Acid-fast staining revealed mycobacterial accumulation in the cytoplasm (Figure 5C).