PMC4705617_01
Clinical course (Panel a), antibiotic regimens (Panel b), body temperature and leukocyte count (Panel c) of the 2-year-old patient with hyperpyrexia
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Fig1
Then, he was admitted to the hospital and discharged 8 days later after completing the Human Leukocyte Antigens (HLA) matching (Fig. 1a). Meanwhile, antifungal agent caspofungin acetate (CAS) and antiviral agent acyclovir (ACV) were also administered as prophylaxis (Fig. 1b).  From June 15th to June 24th, patient's body temperature dropped to 38.5  C from 40.5  C, then rose to 40.3  C again (Fig. 1c). Then, his primary care physician decided to switch drugs to linezolid (LZD) against gram-positive cocci, tobramycin (TOB) against gram-negative bacteria for a week, and voriconazole for fungal prophylaxis (Fig. 1b). Considering the medication safety, the doctor stopped using TOB and LZD, and changed to use the rifampicin (RFP) and fusidic acid against gram-positive bacteria and tazocin against drug-resistance gram-negative bacteria (Fig. 1b). Finally, we got the informed consent of patient's mother on behalf of the patient for detecting potential pathogens based on NGS technology (Fig. 1a). 
The situation of skin rashes on patient's body in two time-points (pre- and post-treatment). The patient presented hyperpyrexia with black rash all over his body in the first detection (Panels a, b). The patient's body temperature returned to normal with the rash fading in the second detection (Panels c, d)
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Fig2
HSCT. His vital signs were normal, and physical examination was unremarkable except some discrete old rashes on skin (Fig. 2). Over the next 5 days, the patient gradually recovered with his body temperature returning to normal range and his old rash fading (Fig. 2c/d).
The results of chest X-ray, CT of patient. The chest X-ray images showed slightly increased lung-markings from Jun 17th to July 9th (Panels a, b), and images of chest CT revealed pneumonia in the posterior basal segment oflower lobe of right lung on July 22nd (Panels c, d)
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Fig3
After a week, the computed tomography (CT) of chest showed pneumonia in the posterior basal segment of the lower lobe of right lung (Fig. 3c/d), and CRP became 0.2 mg per liter (normal range, 0 to 5 mg per liter), but his body temperature still fluctuated between 37.7  C and 39  C.
Diagnosis of P. acnes infection by the NGS-based method: mapping of P. acnes reads (Panel a) and sequences in blood of two detections (Panel b)
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Fig5
Propionibacterium acnes (P. acnes, G +) genome. P. acnes accounted for a very high proportion in detectable microorganisms and possessed a high coverage of genome, which was also significantly higher than control (Fig. 5).