PMC8039304_01
Chest CT scans in different phases. (A) Ground-glass nodules in the upper lobe of the right lung with multiple enlarged lymph nodes in the mediastinum which were suspected of tumors. (B) Infectious lesions in both lungs, left hilar shadow increased, and mediastinal lymph nodes slightly enlarged. (C) The area of pneumonia was larger than before and pleural fluid appeared. (D) Pneumonia and pleural effusion were both absorbed obviously.
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F1
His chest computerized tomography (CT) scan revealed ground-glass nodules in the upper lobe of the right lung with multiple enlarged lymph nodes in the mediastinum which were suspected of tumors (Figure 1A). Re-examination of chest CT showed infectious lesions in both lungs, left hilar shadow increased, and mediastinal lymph nodes slightly enlarged (Figure 1B). WBC increased slowly (Figure 3). We ordered another chest CT scan which indicated the lesions of pneumonia were larger than before and pleural fluid appeared (Figure 1C). On December 9th, his repeated chest CT scan showed that pneumonia was cured and pleural effusion were absorbed obviously (Figure 1D).
Temperature curve. The horizontal axis indicates the date and the vertical axis indicates highest daily ear temperature.
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F2
However, the peak temperature did not drop (Figure 2), and the inflammation indexes did not improve (Table 3).
The result of prolonged sputum culture. A diffusible red pigment produced by Talaromyces marneffei, diffuses to the surrounding medium.
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F3
WBC increased slowly (Figure 3). We ordered another chest CT scan which indicated the lesions of pneumonia were larger than before and pleural fluid appeared (Figure 1C). Moreover, we prolonged sputum culture time to one week and the fungus was further validated by culture (Figure 3).
Fiberoptic bronchoscopy. (A,B) showed the mucosa of the left and right main bronchus is scattered with nodules. (C) Longitudinal change of mucosa in the basal segment of the left lower lobe.
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F4
On November 5, he underwent a fiberoptic bronchoscopic examination (Figure 4) and lavage of the basal segment of the left lower lobe.
Timeline of the case.
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F5
The whole process was concluded (Figure 5).