PMC10455842_01
(A) Initial lung CT revealed that bilateral patchy exudation with increased density and indistinct margins. (B) Initial brain enhanced MRI revealed that an irregular mass measuring 3.5x2.5x3.2cm was identified in the right occipital lobe, exhibiting significant enhancement with an uneven ring and large flake edema surrounding it. The adjacent cerebral sulci were narrowed and disappeared, while compression caused narrowing of the right lateral ventricle. (C) Second brain enhance MRI, conducted 9 days after craniotomy, revealed an improvement in the compression of the right lateral ventricle. (D) Second chest CT, conducted 1 month after antifungal treatment, showed significant absorption of the lesion.
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A chest computed tomography (CT) showed multiple high-density patches of shadows in both lungs (Figure 1A). Brain CT showed a cerebral infarction in the right occipital lobe, and brain enhanced magnetic resonance imaging (MRI) showed an irregular lesion measuring up to 3.5 cm x 2.5 cm x 3.2cm. (Figure 1B). With the implementation of the aforementioned treatment, there was a significant improvement in his symptoms including headache, gait imbalance and vision loss in both eyes, as well as complete resolution of the intracranial mass (Figure 1C). After 1-month treatment, CT scan showed improvement in lung lesions (Figure 1D), and there was no change in brain MRI.
(A) Talaromyces marneffei was isolated from the BALF: Yellow colony on Sabouraud's dextrose slant at 37 C in left, and yellow colony with distinctive red diffusible pigment on Sabouraud's dextrose slant at 25 C in right. (B) Histopathology of the right occipital lobe mass: Microscopic examination of brain tissue revealed areas of necrotic tissue and granulation tissue formation, accompanied by significant neutrophil infiltration, which is indicative of a chronic brain abscess.
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T. marneffei isolated from sputum and bronchoalveolar lavage fluid (BALF) culture (Figure 2A), while blood cultures were negative. Histological examination of brain tissue revealed no evidence of malignancy but suggested the presence of a chronic brain abscess with Gram-positive filamentous bacilli (Figure 2B).