PMC8718678_01
Clinical course of the patient (schematic). BDG, (1,3)-b-D-glucan; PCT, procalcitonin; CRP, c-reactive protein; CT, computed tomography; MRI, magnetic resonance imaging; MRA, magnetic resonance angiography; VRC, voriconazole; IPI, Imipenem; VAN, Vancomycin; TEC, teicoplanin; AmBL, liposome-associated amphotericin B; mNGS, metagenomics next-generation sequencing; PB, peripheral blood; CSF, cerebral spinal fluid; BAL, bronchoalveolar lavage fluid.
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F1
An outline of the episodes is showed in Figure 1. No pathogen could be detected, and the patient experienced neutropenia from day 10 to day 25 (Figure 1). No obvious abnormality was showed by magnetic resonance angiography (MRA) of patient's brain, but CT scans of the lung showed multiple hyperdense lesions on day 18 (Figure 1).
CT imaging for the patient's brain. (A) On day 25, a CT scan of the brain showed hyperdense lesions with surrounding edema in the right parietal lobe (red arrow) and hypodense areas (blue arrow) in the left and right parietal lobes. (B,C) After 2 and 3 weeks of treatment, a CT scan showed that the lesions were absorbed in the left and right brain (red arrow and blue arrow).
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F2
After 2 and 3 weeks of antifungal treatment, CT scans showed that lesions were obviously absorbed both in the brain (Figure 2) and the lung (Figure 3), and PCT and CRP were also recovered following antifungal therapy (Figure 4).
CT imaging for the patient's lung. (A) On day 25, a CT scan of the lung showed multiple inflammatory lesions (red arrow) and small amount of bilateral pleural effusion in both lungs. (B) After 2 weeks of treatment, a CT scan showed that the lesions were absorbed in the right side of patient's lung. (C) After 3 weeks of treatment, a CT scan showed that lesions were significantly absorbed in the right side of patient's lung (red arrow) and smaller amount of bilateral pleural effusion in the side of patient's lung than that after 2 weeks of treatment.
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F3
After 2 and 3 weeks of antifungal treatment, CT scans showed that lesions were obviously absorbed both in the brain (Figure 2) and the lung (Figure 3), and PCT and CRP were also recovered following antifungal therapy (Figure 4).
Daily course of the patient's treatment. Horizontal thick blue lines show the medications administered; VRC, voriconazole; AmBL, Liposome-associated amphotericin B; TZP, piperacillin-tazobactanm; IPI, Imipenem; PCT, procalcitonin; CRP, C-reactive protein.
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F4
After 2 and 3 weeks of antifungal treatment, CT scans showed that lesions were obviously absorbed both in the brain (Figure 2) and the lung (Figure 3), and PCT and CRP were also recovered following antifungal therapy (Figure 4).