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case_images: Chest CT image. (A) A mixed ground glass (4.2*3.7 cm) in the posterior segment of the upper lobe of the right lung on admission (2023-2-28). (B) After effective antifungal therapy, the mixed ground glass opacity (2.5*1.4 cm) in the posterior segment of the upper lobe of the right lung was reduced on March 14, 2023. (C) After effective antifungal therapy, the nodule (11*7 mm) in the posterior segment of the upper lobe of the right lung continued to reduce on April 7, 2023. (D) The nodule (approximately 8 mm) in the posterior segment of the upper lobe of the right lung continued to reduce on April 22, 2023.
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case_images: Figure 1 showed the dynamic changes of lung lesions during the patient's hospitalization, as shown by four chest CT scans. After admission, a chest CT scan revealed a mixed ground glass lesion in the posterior segment of the right upper lobe of the lung, with potential for inflammation or tumor (Figure 1A). March 13, 4.72 mg/L; on April 7, 3.16 mg/L), which was within the recommended range (2-5 microg/mL), so the dose was not adjusted. Moreover, 3 chest CT scans, which were performed on March 14, 2023, April 7, 2023, and April 22, 2023, showed that the lung lesion was almost completely absorbed (Figure 1B-D); therefore, VRC was discontinued on April 27, 2023 (Figure 3).
case_images: Confirmation of TM specific amplification from lung tissue by NGS. (A) The reads mapped to TM derived from NGS data. A total of 51 reads were mapped to TM in the reference database, which contains approximately 2764 pathogen genomes and has a total coverage of 0.0127%. (B) The distribution of microbe sequences (N = 2764 reads) identified in patient plasma, including TM (N = 51; 1.85%), human gammaherpesvirus 4, Pseudomonas sp.R9.37 and others.
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case_images: NGS of the biopsy confirmed lung infection with TM (n = 51 reads) and human gammaherpes virus 4 (n = 17 reads) 2 days later (Figure 2).
case_images: Timeline of the patient with relevant data on the episodes and interventions.
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case_images: AMPB was given since March 4 (Figure 3). March 13, 4.72 mg/L; on April 7, 3.16 mg/L), which was within the recommended range (2-5 microg/mL), so the dose was not adjusted. Moreover, 3 chest CT scans, which were performed on March 14, 2023, April 7, 2023, and April 22, 2023, showed that the lung lesion was almost completely absorbed (Figure 1B-D); therefore, VRC was discontinued on April 27, 2023 (Figure 3).
case_images: Gastroscopy: gastroesophageal varices (severe), portal hypertensive gastropathy.
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case_images: An upper endoscopy revealed severe gastric and esophageal varices and portal hypertensive gastropathy (Figure 4).