PMC9426957_01
Chest X-ray at initial presentation: anteroposterior (A) and lateral (B) views
3423_Fig2.jpg
PMC9426957_01_3423_Fig2.jpg
f2-3423-1-29486-1-10-20220708
A 40-year-old man was referred to our pulmonology department because of an aberrant chest X-ray (Fig. 2).
HRCT of the lungs at initial presentation
3423_Fig3.jpg
PMC9426957_01_3423_Fig3.jpg
f3-3423-1-29486-1-10-20220708
High-resolution computed tomography (HRCT) revealed bilateral randomly distributed millimetric nodules (Fig. 3).
HRCT after 4 weeks of treatment with prednisone showing diffuse bilateral consolidations
3423_Fig4.jpg
PMC9426957_01_3423_Fig4.jpg
f4-3423-1-29486-1-10-20220708
HRCT showed progression with the formation of consolidations (Fig. 4).
Histological analysis shows the presence of fungal hyphae (A, indicated with a white arrow) and a granuloma (B)
3423_Fig5.jpg
PMC9426957_01_3423_Fig5.jpg
f5-3423-1-29486-1-10-20220708
This demonstrated extensive inflammation with granulomas and the presence of fungal hyphae (Fig. 5).
Flow cytometric dihydrorhodamine (DHR) 123 assay results in our patient (A) and a healthy control (B). Y-axis indicates neutrophil cell count, x-axis indicates fluorescence intensity of neutrophils. (A) Left: The MFI (mean fluorescence intensity) of non-stimulated neutrophils is 1.960. Middle: The MFI of unstimulated neutrophils probed with the DHR123 dye. Right: By stimulation of phorbol myristate acetate (PMA) neutrophils produce superoxide radicals resulting in the oxidation of DHR123 to fluorescent R123. The MFI of neutrophils stimulated by PMA is 1.945. This indicates deficient neutrophil oxidizing activity. (B) Left: The MFI of non-stimulated neutrophils is 1.677. Middle: The MFI of unstimulated neutrophils probed with the DHR123 dye. Right: The MFI of neutrophils stimulated by PMA is 150.275. This indicates normal oxidation and fluorescence of DHR 123 by the neutrophils.
3423_Fig6.jpg
PMC9426957_01_3423_Fig6.jpg
f6-3423-1-29486-1-10-20220708
A DHR 123 test in the haematological department was arranged and was positive for CGD (Fig. 6).