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case_images: (A) Coronal plane CT scan shows bilaterally enlarged adrenals, and lytic lesions of the right side of T4, L2, L3, and L5 vertebral bodies and pelvic bone. (B) T2-weighted MRI shows high marrow signals in C7 and T4 vertebral bodies. There is some compression of the T4 body and extension into the right pedicle.
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case_images: Peripheral chest and abdominal CT examination showed lytic lesions of C7, T1-5, T8, L2-3, and L5 vertebral bodies, bilateral ribs and pelvic bone, tissue mass shadow, and bilateral adrenal mass, considering the possibility of bone metastases (Figure 1A). A MRI scan shows further bone lesions of the thoracic spine and compression of the spinal cord (Figure 1B).
case_images: Histopathology and cytology of histoplasmosis. (A) Periodic acid-Schiff stain with many yeasts in bone lesion biopsy (original magnification x400). (B) Periodic acid-Schiff stain with numerous yeasts in multinucleated giant cells (original magnification x400). (C) Periodic acid-Schiff stain with a large number of yeasts inside and outside the cell (original magnification x1000). (D) Gomori-Grocott methenamine silver stain showing intracellular yeast forms in bone biopsy (original magnification x1000).
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case_images: The biopsy of the pelvic bone lesion discovered some phagosomes in the cytoplasm that were suspected to be H. capsulatum. (Figure 2).
case_images: Diagnosis of H. capsulatum infection through metagenomic Next-Generation Sequencing (mNGS). (A) Coverage depth map of the Sample mapped to H. capsulatum GCA_000313325.1 genome. (B) Phylogenetic tree results of Histoplasma capsulatum var. capsulatum.
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case_images: Tmu) from Taiwan, China which was consistent with the genotyping results. The coverage depth map between our sample and the GCA _000313325.1 of the H. capsulatum genome showed consistency, and the genome corresponds to Histoplasma capsulatum var. capsulatum shown in Figure 3.
case_images: The curve of body temperature, serum (1,3)-beta-D-glucan test, and treatment course during hospitalization.
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case_images: After six days of antifungal treatment, the patient's body temperature slowly got back to normal, and his general condition improved (Figure 4).