case_images: PMC9485662_01
case_images: Radiographic progression of lungs.
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case_images: F1
case_images: CT showed multiple infectious lesions, some nodules with cavities in both upper lungs, a small amount of pleural and pericardial effusion, and progressive lesions compared with the CT film from another hospital (Figure 1). Considering that the fever was caused by aggravation of the pulmonary infection, levofloxacin was changed to moxifloxacin hydrochloride in sodium chloride injection 0.4 g qd.
case_images: Results of the metagenomic next-generation sequencing.
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case_images: F2
case_images: Beijing, China), and A. fumigatus (227 reads), N. nova (148 reads), M. tuberculosis (1 read), human alphaherpesvirus 1 (39 reads), and human cytomegalovirus (11 reads) were detected (Figure 2). Briefly, for the mNGS method, the collected BALF specimen was centrifuged at 5,000 g and at room temperature for 10 min, and DNA was extracted from the supernatant using the TIANamp Micro DNA Kit (DP316, Tiangen Biotech). A needle biopsy of the left upper lung tissue was also performed, and the mNGS of the lung tissue revealed N. nova (92 reads) and human cytomegalovirus (2 reads) (Figure 2).
case_images: Histopathological results of the lungs.
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case_images: F3
case_images: The histopathological examination of the lungs revealed purulent inflammation with fibrinous inflammation (Figure 3).
case_images: Imaging of the lungs after treatment.
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case_images: F4
case_images: On day 24 of admission, the repeat chest CT showed improvement of the pulmonary infection (Figure 4), CMV DNA was negative, and "ganciclovir" was discontinued.