PMC9120773_01
Bronchoscopy liquid-based cytology showed Aspergillus.
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The lung fiber bronchoscopy showed abnormal echogenic lesions in the right lower lung basal segment, and bronchoscopy liquid-based cytology showed Aspergillus ( Figure 1 ).
CT-scan of the lungs in the early stage of disease (A), after treatment (B-D), review after one month (E), and review after three months (F).
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Blood routine showed that WBCs were 0.63x10^9/L, and lung CT showed a mass in the right lower lung ( Figure 2 ). When the lung CT on April 8 showed further improvement ( Figure 2 ), Cladribine was administrated at 0.14mg/Kg/day daily for 5 days.
The flow phenotype of the blood cells presented as two-dimensional graphs.
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T cells (0.8%) ( Figure 3 ). TCR test showed positive gammadelta rearrangement, and metagenomic next-generation sequencing (mNGS) detected Aspergillus.
Large granular lymphocytes in bone marrow cytology smear.
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The results of the bone marrow smear showed active bone marrow hyperplasia with increased erythrocyte colonies and decreased lymphocyte colonies compared to those of the last time ( Figure 4 ).
Fusion gene NPL-DHX9 rearrangement through an RNA-sequencing analysis.
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The signal transducer and activator of the transcription-3 (STAT3) Y640F mutation and fusion gene NPL-DHX9 rearrangement were confirmed by RNA-sequencing analysis ( Figure 5 ). The patient was diagnosed with gamma/delta variant T-cell LGL leukemia (NPL-DHX9 positive) on March 22.
Timeline of disease and treatment periods.
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The timeline of the disease and treatments are shown in  Figure 6 .