PMC9986280_01
(A) The first bronchoscope showing a little mucus in the airway. (B) Three-dimensional computed tomography reconstruction of lung window showing a round and high-density shadow in the basal segment (arrows). (C) The bronchoscopic image showing plenty of white secretion in the tracheal inner membrane (arrows). (D) After one year, chest computed tomography showed the nodule shadows was smaller than before, and the calcification was obvious. (E) One year after treatment, tracheoscopy showed no secretion adhesion in the trachea. (F) The lactophenol cotton blue of lavage fluid-stained slide on day 33 showing Talaromyces marneffei with broom-like branches (oil immersion lens, 1000x magnification). (G)
T. marneffei coverage and depth in BALF metagenome next-generation sequencing (mNGS). (H)
Pneumocystis jirovecii coverage and depth in BALF mNGS.
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Electronic bronchoscope showed endobronchial inflammation ( Figure 1A ). On day 26, Chest CT showed multiple enlarged necrotic lymph nodes in the hilus and mediastinum and a high-density round shadow in the basal segment in the right lung inferior lobe ( Figure 1B ). On day 32, the second bronchoscope observed plenty of mucus in the inner tracheal membrane ( Figure 1C ). T. marneffei ( Figure 1F ). Figure 1G ) and P. jirovecii ( Figure 1H ), respectively. 158 reads aligned to S. pneumoniae. Following the pathogen results, cefoperazone sodium sulbactam sodium (on days 33-39), itraconazole (on days 33-45), and trimethoprim-sulfamethoxazole (on days 33-45) were commenced as the targeted antimicrobial therapy ( Figure 2 ). One year after discharge, the chest CT image was improved, indicating calcification of the primary lesion ( Figure 1D ). The bronchoscope showed that the white mucus in the tracheal membrane disappeared totally ( Figure 1E ).
The white blood cell (WBC) count, C-reactive protein (CRP) concentration, detected pathogens and therapy methods during the hospital stay.
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After admission, the patient was given amoxicillin sulbactam (on days 2-6) and azithromycin (on days 5-7) for anti-infective therapy ( Figure 2 ). Anti-infective therapy was switched to methylprednisolone (on day 15), followed by prednisone (on days 16-20) ( Figure 2 ). Upon admission, CRP concentration was elevated (50.84mg/L) ( Figure 2 ). Figure 1G ) and P. jirovecii ( Figure 1H ), respectively. 158 reads aligned to S. pneumoniae. Following the pathogen results, cefoperazone sodium sulbactam sodium (on days 33-39), itraconazole (on days 33-45), and trimethoprim-sulfamethoxazole (on days 33-45) were commenced as the targeted antimicrobial therapy ( Figure 2 ).
The Sanger sequencing results of the mutation site (c.820C>T, p.R274W) in STAT1 gene of the patient and his family.
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Verification of this variant site using sanger sequencing showed negative results in his family, and it was a de novo variant in this patient ( Figure 3 ).