PMC9526550_01
Left neck enlarged lymph nodes with healed scars (a) and flexible bronchoscopy (b) showing severe diffuse bronchitis with distal necrotic tissues.
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Physical examination revealed left neck enlarged lymph nodes with healed scars (Figure 1).
The chest CT scan showed patchy alveolar opacification (a) with multiple superior mediastinal lymph nodes (b).
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A chest CT scan showed bilateral diffuse air space disease (Figure 2). The bronchoscopy was done at the higher center, which showed diffuse bronchitis with necrotic involving mainstem bronchi (Figure 2).
Demonstration of yeast in a direct smear made from sputum; note the presence of pseudohyphae and budding yeast cells (a). Growth of yeasts from sputum sample (strain mat532y) on SDA medium (b) and an indirect smear displaying yeast cells (LPCB x100) (c).
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On 29 November 2018, the demonstration of yeast in a smear made from sputum and the appearance of pseudohyphae and budding yeast cells (Figure 3(a)) dictated the need for fungal culture. Candida species following protocols described by the manufacturer (bioMerieux Inc., Durham, NC 27712, USA). Candida tropicalis were isolated from a sputum specimen's culture (Figures 3(b) and 3(c)), which raised the possibility of invasive mycosis due to underlying primary immunodeficiency.