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case_images: Abdominal CT revealed multiple cystic foci in the adnexa bilaterally (A). Chest CT showed scattered striated foci in both lungs with thickening of some lobular septa (B).
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case_images: Abdominal CT examination showed enlargement of the liver and spleen and multiple cystic lesions in the bilateral adnexa. (Figure 1A) We also performed head CT, chest CT, urological ultrasonography, thyroid ultrasonography, routine echocardiography and other related tests, all of which yielded negative results. (Figure 1B) After admission, we continued to administer anti-infective treatment with imipenem/cilastatin sodium (500 mg every 8 h), but the patient still had recurrent fevers.
case_images: Wright's staining (1000x), some phagocytes phagocytized suspected Histoplasma capsulatum in the cytoplasm (A). These fungi are surrounded by a transparent halo (B).
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case_images: Then, we performed a bone marrow smear and found some phagosomes in the cytoplasm that were suspected to be Histoplasma capsulatum. (Figure 2) The bone marrow fluid was subjected to mNGS analysis on Day 4 of hospitalization. mNGS was performed according to the standard protocol of Illumina sequencing on the NextSeq550 platform.
case_images: The curve of body temperature during hospitalization. Antifungal therapy with amphotericin B and v fluorouracil tablets was administered from day 5 after admission.
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case_images: After active treatment, the patient's general condition improved, and her body temperature gradually returned to normal. (Figure 3) Prior to discharge, the patient's interleukin 2 receptor and procalcitonin returned to normal levels. (Table 1) A bone marrow smear did not reveal Histoplasma capsulatum.