case_images: PMC10583546_01
case_images: Chest CT scan: subcarinal lymphadenopathy, irregular soft tissue mass in the left hilum and uneven enhancement on the enhanced scan (A) Lung window; (B) Enhanced scanning); Lesions were significantly absorbed on chest CT scans after 16 days of voriconazole treatment (C) Lung window; (D) Mediastinal window); Lesions disappeared on chest CT scans after 6 months of voriconazole treatment (E) Lung window; (F) Mediastinal window); CT-guided percutaneous puncture of the left lower lung biopsy (G) Lung window; (H) Mediastinal window).
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case_images: His chest computed tomography (CT) scan found a large hilar lesion (57 mm * 33 mm * 59 mm) combined with air bronchogram and bronchiarctia inside, multiple mediastinal lymph node enlargements ( Figure 1A ), especially subcarinal lymphadenopathy (29 mm*17 mm), local interlobular septal thickening and patchy high-density shadows in the left lung with blurred edges, multiple solid nodules in both lungs, and contrasted CT scan showed mild to moderate enhancement ( Figure 1B ). The patient's lesions were significantly absorbed on chest CT scans ( Figures 1C, D ). After six months of voriconazole treatment, he recovered from the  T. marneffei infection well, his lesions disappeared on chest CT scans ( Figures 1E, F ).
case_images: Bronchoscopy, EBUS-TBNA and histopathology: (A) Red and swollen infiltration of the left bronchial mucosa, aggravation of lumen stenosis, new organisms with purulent spots; (B) The left bronchial mucosal lesions were absorbed, the neoplasm disappeared, and the bronchial stenosis was significantly relieved after 16 days of voriconazole treatment; (C) EBUS showed ultrasound hypoechoic area; (D) EBUS-TBNA of subcarinal lymph node; Histopathology analysis: Hematoxylin-eosin staining revealed inflammatory granulation tissue hyperplasia, a large number of lymphocytes, plasma cells, and neutrophils infiltration (E) x100; (F) x400).
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case_images: A new peanut-sized organism was seen at the inferior lobe bronchus with purulent spots ( Figure 2A ). A 40 mm * 30 mm ultrasonic hypoechoic region was detected by ultrasound bronchoscopy in the 7th lymph node ( Figure 2C ), and a 20 mm * 15 mm hypoechoic area was detected in the 11th lymph node of the left lung. Both ultrasonic hypoechoic regions were punctured and extracted again with the guidance of ultrasound bronchoscopy ( Figure 2D ). Histopathological analysis showed inflammatory granulation hyperplasia in the lamina propria of the new organism of bronchial mucosa and infiltration of many lymphocytes, plasma cells, and neutrophils ( Figures 2E, F ). On the 16th day of voriconazole treatment, bronchoscopy revealed that the lesion and airway stenosis had been relieved ( Figure 2B ).
case_images: Content of T. marneffei in samples of each group (species and family level, (A) histogram, (B) component ratio). (C) QPCR amplification curve of each sample.
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case_images: On January 30th, mNGS reported that Talaromyces was detected in lymph node puncture tissue, with 783 Talaromyces nucleotide sequences (relative abundance: 92.45%) and 775  T. marneffei nucleotide sequences (relative abundance: 91.50%), ( Figure 3A ). In addition, 207 Talaromyces nucleotide sequences (relative abundance: 85.64%) and 204  T. marneffei nucleotide sequences (relative abundance: 84.30%) were identified in the mNGS of bronchial neobiological tissue ( Figure 3B ). While the patient's bronchial neobiological tissue samples were amplified with mycobacterium tuberculosis IS6110 gene primers, and the reaction was negative (CT>40): The amplification curve is shown in  Figure 3C .
case_images: Timeline of T. Marneffei Infection patient.
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case_images: The timeline can be seen in the  Figure 4 .