PMC7431457_01
Chest images. (A) Chest X-ray showing bilateral patchy, cloudy opacities in the lower lungs with some adjacent pleural thickening and adhesion before treatment. (B and C) Chest HRCT showing diffused stripes as well as reticular and ground-glass opacities with honeycomb structures, primarily in the lower lungs before treatment. (D and E) Chest HRCT scan showing a faint patchy opacity in the lateral segment (white arrow).
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China (2016 edition). Two weeks prior to admission to our hospital, she presented to a local community hospital with complaints of fever, cough and dyspnea during daily activity. Chest X-ray showed bilateral patchy, cloudy opacities in the lower lungs with some adjacent pleural thickening and adhesion (Figure 1A). High-resolution computed tomography (HRCT) demonstrated diffused stripes and reticular and ground-glass opacity with honeycomb structures, primarily in the lower lungs (Figure 1B and C). One week after transbronchial lung biopsy (5 days after receiving mNGS report), pathological examination of lung biopsy with hematoxylin-eosin (HE) stain (Figure S1a) reported that alveolar spaces were filled with abundant foamy or granular eosinophilic exudate as well as a few lymphocytes infiltrate; the alveolar septa became thickened due to edema and dilated capillaries. Gomori methenamine-sliver staining of the lung biopsy displayed a plenty of dark brown oval or cup-shaped organisms in alveolar spaces, consistent with the morphology of P. jirovecii (Figure S1b). At her 2-week follow-up visit, she had no symptoms and chest HRCT scan exhibited no abnormal finding except for a faint patchy opacity in the lateral segment (Figure 1D and E).