case_images: PMC9702513_01
case_images: Case 1. (A,B) Outpatient lung CT; (C,D) 9 days after admission, pulmonary inflammation worsened, nodules increased, and lymph nodes were more enlarged.
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case_images: F1
case_images: The patient lost 1.5 kg since the onset of the fever and was treated with ibuprofen and amoxicillin, but when symptoms did not improve, he came to the outpatient department of our hospital for a lung CT which showed enlarged space occupying right hilum and mediastinal lymph node enlargement, left lower lung nodules, double pneumonia (Figure 1). Nine days after admission, the patient's chest CT showed a space occupying lesion in the right hilum, multiple enlarged lymph nodes in the mediastinum, nodules in the left inferior lobe, thickening of bilateral interlobular septa and thickening of the right lobular septa and thickening of the right, lobular fissure, pneumonia (Figure 1).
case_images: Case 1. (A,B) Chest CT 1 month after hospitalization showed improved pulmonary inflammation and reduced lesions; (C,D) Chest CT reexamination 38 days after admission showed more absorption of lesions, and significantly improved lung inflammation.
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case_images: F2
case_images: Chest CT scan 1 month after hospitalization showed reduced pulmonary inflammation and lesion (Figure 2). Chest CT on day 38 showed that more of the lesions were absorbed, and lung inflammation significantly improved (Figure 2).
case_images: Case 1. (A,B) Chest CT 4 months later showed improved lung lesions; (C,D) and scar formation in the right middle lobe bronchus 8 months later.
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case_images: F3
case_images: On follow-up 4 months later, the patient was in good general condition, with good sleep and no significant change in body weight, and his lung lesions improved on chest CT (Figure 3). This patient came back for reexamination eight months later, and his CT showed scar formation in the right middle lobe bronchus, and a few thin secretions were seen during bronchoscopy (Figure 3).
case_images: (A) Case 1. Timeline of infection progression. (B) Case 2. Timeline of infection progression. (C) Case 3. Timeline of infection progression.
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case_images: F6
case_images: Intermittent fever and increased inflammatory markers persisted even after combined treatment with rifamycin, cefepime, levofloxacin, and azithromycin (Figure 6C). Because her overall response to the treatment was not ideal, the regimen was changed to a combination of amikacin, moxifloxacin, and cefoxitin, after which the patient's body temperature became stable, suggesting that this antibiotic regimen was effective (Figure 6C).
case_images: PMC9702513_02
case_images: Case 2. (A,B) Lung CT on the day of admission showed interstitial inflammation in both lungs and cavity formation in the upper lobe of the right lung, localized emphysema of both lungs, mediastinal lymph node enlargement, and bilateral localized pleural thickening; (C,D) 1 month later, CT examination showed that the double pneumonia was slightly more advanced than before.
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case_images: F4
case_images: Lung CT showed interstitial inflammation in both lungs, a cavitary lesion in the upper lobe of the right lung, localized emphysema in both lungs, mediastinal lymph node enlargement, and bilateral localized pleural thickening (Figure 4). CT examination on her one-month follow-up showed a slight progression of double pneumonia since being discharged from the hospital (Figure 4).
case_images: (A) Case 1. Timeline of infection progression. (B) Case 2. Timeline of infection progression. (C) Case 3. Timeline of infection progression.
case_images: fpubh-10-972280-g0006.jpg
case_images: PMC9702513_03_fpubh-10-972280-g0006.jpg
case_images: F6
case_images: Intermittent fever and increased inflammatory markers persisted even after combined treatment with rifamycin, cefepime, levofloxacin, and azithromycin (Figure 6C). Because her overall response to the treatment was not ideal, the regimen was changed to a combination of amikacin, moxifloxacin, and cefoxitin, after which the patient's body temperature became stable, suggesting that this antibiotic regimen was effective (Figure 6C).
case_images: PMC9702513_03
case_images: Case 3. (A,B) Lung CT on day 1 showed mild lung infection, multiple nodules and thickening of the anterior mediastinal soft tissue; (C,D) Chest CT showed worsened infection in both lungs, multiple small nodules, and new bilateral pleural effusion 2 months later.
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case_images: F5
case_images: Lung CT showed mild infection with multiple nodules and thickening of the anterior mediastinum (Figure 5). CT showed infection in both lungs and multiple small nodules that were more severe than on the last scan, and a new bilateral pleural effusion (Figure 5). Clarithromycin, cefoxitin, and amikacin were added to her regimen based on our experience and treatment guidelines.
case_images: (A) Case 1. Timeline of infection progression. (B) Case 2. Timeline of infection progression. (C) Case 3. Timeline of infection progression.
case_images: fpubh-10-972280-g0006.jpg
case_images: PMC9702513_03_fpubh-10-972280-g0006.jpg
case_images: F6
case_images: Intermittent fever and increased inflammatory markers persisted even after combined treatment with rifamycin, cefepime, levofloxacin, and azithromycin (Figure 6C). Because her overall response to the treatment was not ideal, the regimen was changed to a combination of amikacin, moxifloxacin, and cefoxitin, after which the patient's body temperature became stable, suggesting that this antibiotic regimen was effective (Figure 6C).