PMC8203193_01
Neck CT findings. Mixed-density lesions on the left side of the neck (A). The masses were incised, and a drainage tube was inserted (B). Pus and necrotic materials (C). A large new exudative consolidation shadow was noted in the left upper lobe after 2 weeks of antibacterial treatment (D). Bronchofibroscopy revealed bronchial nodules in the left upper lobes that obstructed the lumen. Mucosal hyperplasia and hypertrophy were also noted (E).
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Computed tomography (CT) of the neck revealed mixed-density lesions on the left side of the neck and in the right submental area (Figure 1A). Resection of the neck masses revealed that they contained pus and a large amount of hemopurulent necrotic material (Figure 1B and C). CT showed that the neck masses shrank, but a large exudative consolidation shadow in the left upper lobe and left hilar lymphadenopathy was also noted (Figure 1D). Bronchofibroscopy revealed bronchial nodules in the left upper and lower lobes, obstructing the lumen, and mucosal hyperplasia and hypertrophy (Figure 1E).
Talaromyces marneffei was isolated from the hilar nodes: Yellow colony with distinctive red diffusible pigment on Sabouraud's dextrose slant at 25 C (A) and yellow colony on Sabouraud's dextrose slant at 37 C (B). Lactophenol blue-stained culture of the ulcerating right supraclavicular subcutaneous mass showing that the conidiophores of this mold were smooth and had a size of 3 um, each of which had several phialides and produced smooth, spherical conidia in chains (C).
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TM (Figure 2) was cultured from a bronchial nodule, left hilar lymph node, and bronchoalveolar lavage fluid.
Computed tomography findings. Chest: The pulmonary lesions were markedly improved after 3 weeks of antifungal therapy (A). Neck: An abscess in the posterior pharyngeal wall, a fracture of the 4th cervical vertebra (B), and new mass on the right side of the neck (C) were found. The abscess disseminated to the lower right neck and sternum (D).
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CT scan revealed significant improvement in the pulmonary lesions (Figure 3A). CT of the neck showed an abscess in the posterior pharyngeal wall, a fracture of the 4th cervical vertebra, and a mass on the right side of the neck (Figure 3B and C). Ceftazidime and levofloxacin were added as antibacterial treatment, but there was no obvious treatment effect. The pulmonary lesions were improved, but the neck abscess could not be contained and disseminated widely to multiple body parts (Figure 3D).
Neutralizing anti-interferon-gamma autoantibody titers of the patient after admission. The dotted line indicates the level of the positive titer at each certain time point, peaking at 50,566 ng/mL at 8 weeks after admission.
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Wuhan, China) according to the manufacturer's protocols. We found that he had a persistently high positive titer (11,025 ng/mL), and the antibody titer increased gradually to 50,566 ng/mL at 8 weeks after admission (Figure 4).