case_images: PMC10710253_01
case_images: (A) Pulmonary CT showed bilateral pneumonia; (B) Abdominal CT indicated irregular nodular or slightly low-density shadows with multiple soft tissue densities in the right renal hilum, right retroperitoneal space, and right pelvic extraperitoneal space, with the largest of those locating in front of the right iliac muscle (white Arrow), measuring about 52mm x 38mm, suggesting infectious lesions and encapsulated effusion.
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case_images: Pulmonary CT showed bilateral pneumonia, tracheal diverticulum, multiple bilateral rib old fractures and a small amount of pericardial effusion (Figure 1A). Abdominal CT indicated irregular nodular or slightly low-density shadows with multiple soft tissue densities in the right renal hilum, right retroperitoneal space, and right pelvic extraperitoneal space, with the largest of those locating in front of the right iliac muscle, measuring about 52mm x 38mm, suggesting infectious lesions and encapsulated effusion (Figure 1B).
case_images: (A) Gram staining of the puncture fluid showed elongated, branching Gram- positive bacteria, with beaded filamentous structures; (B) The modified acid-fast staining showed acid-fast thin branching bacterium; (C) Small, dry, wrinkled pale yellow colonies appeared on the blood agar; (D) Examination of the colonies under a 10x objective lens showed abundant aerial hyphae on agar medium.
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case_images: PMC10710253_01_IDR-16-7447-g0002.jpg
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case_images: Gram staining of the puncture fluid showed elongated, branching Gram-positive bacteria, with beaded filamentous structures (Figure 2A), which was suspected actinomycosis. However, the modified acid-fast staining showed acid-fast thin branching bacterium, which highly suspected the presence of Nocardia infection (Figure 2B). Small, dry, wrinkled, pale yellow colonies appeared on the blood agar (Figure 2C) and examination of the colonies under a 10x objective lens showed abundant aerial hyphae on agar medium (Figure 2D), which was further dentified as N. farcinica by MALDI-TOF MS (Bruker, France, reference database version is V10 9607MSPs).
case_images: Dynamic changes of laboratory examination. (A) WBC, NEU significantly decreased; (B) CRP significantly decreased; (C) PCT significantly decreased; (D) Temperature returned to normal; (E) Abdominal abscesses has been notably absorbed.
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case_images: After 27 days of treatment, the patient's temperature returned to normal, inflammatory markers significantly decreased (Figure 3A-D), and the abdominal abscesses were notably absorbed (Figure 3E), indicating improvement in the condition and the patient can be discharged.