case_images: PMC11387800_01
case_images: : Computer tomography of the chest on admission showed severely reduced lung volumes and thick fibrotic bands and findings were interpreted as severe bilateral lung fibrosis and subpleural densities as marked by the yellow arrow.
case_images: gr1.jpg
case_images: PMC11387800_01_gr1.jpg
case_images: fig0005
case_images: A computed tomography (CT) of the chest with contrast showed severely reduced lung volumes and thick fibrotic bands distorting the lung parenchyma interpreted as persistent moderate to severe upper to midlung predominant fibrosis, subpleural reticular densities and bronchiectasis in the peripheral aspects of the right middle lobe (Fig. 1).
case_images: : Computer tomography of the abdomen and pelvis showing splenomegaly marked by the yellow line (Axial View).
case_images: gr2.jpg
case_images: PMC11387800_01_gr2.jpg
case_images: fig0010
case_images: A CT scan of the abdomen and pelvis showed nodular liver contour, moderate ascites, heterogenous, splenomegaly and a normal biliary tree (Fig. 2).
case_images: : Computer tomography of the head without contrast showing hydrocephalus.
case_images: gr3.jpg
case_images: PMC11387800_01_gr3.jpg
case_images: fig0015
case_images: A CT head now showed marked hydrocephalus, no obstructing mass lesion, and chronic microvascular ischemic changes (Fig. 3).
case_images: : Bone marrow biopsy showing Multiple necrotizing granulomata (H&E; 10x).
case_images: gr4.jpg
case_images: PMC11387800_01_gr4.jpg
case_images: fig0020
case_images: ATT with RIF 600 mg daily, PZA 2500 mg daily, Linezolid 600 mg twice daily, Amikacin 15 mg/kg daily, Levofloxacin 750 mg daily and dexamethasone 0.4 mg/kg/daily on hospital day 31. A bone marrow biopsy of right iliac crest was performed on hospital day 29 revealing multiple necrotizing granulomas, however the AFB, GMS stains were negative (Fig. 4, Fig. 5).