case_images: PMC10964487_01
case_images: Chest CT scan of case 1. (A) The mediastinal window, showing multiple mediastinal lymph node enlargements (white arrow). (B) The lung window, showing uniform ground-glass exudation in both lungs. The left upper lung sees the irregular edge of the nodule (black arrow), and there is a cavity in the middle of the nodule. No obvious pleural effusion was found.
case_images: fcimb-14-1347677-g001.jpg
case_images: PMC10964487_01_fcimb-14-1347677-g001.jpg
case_images: f1
case_images: Chest computed tomography (CT) scan showed bilateral uniform ground-glass exudation, nodules in the anterior segment of the left upper lobe, small nodules in the right lung, mediastinal lymphadenopathy, and hydropericardium ( Figure 1 ).
case_images: The culture performance of T. marneffei in case 1. A denotes a yeast-like colony of T. marneffei ( medium: blood agar plate ) grown at 37  C for 72 hours, showing a light red villous colony with red wine on the back. B is the morphology of T. marneffei under the staining of lactophenol cotton blue. It can be seen that there are single-stranded conidia that are easy to fall off at the top of the double-wheeled broom branches (Magnification,x 1000). C is the state of T. marneffei cultured in Sabouraud Agar Plate at 37  C for 7 days. It can be seen that milky wax-like colonies. D is the state of T. marneffei cultured in Sabouraud Agar Plate at 25  C for 5 days. White velvet-like colonies visible.
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case_images: PMC10964487_01_fcimb-14-1347677-g002.jpg
case_images: f2
case_images: Fungal hyphae were found in the blood culture ( Figure 2 ), and fluconazole was added (400 mg on the first day, 200 mg/day later).
case_images: PMC10964487_02
case_images: Chest CT findings of case 2. (A, B) For admission performance: multiple cords and patchy shadows in both lungs. (C, D) For the third-day performance: double lung (see multiple cords), patchy shadow, part of the range is larger than before, and the density is higher than before. (E, F) For the 10th-day performance: bilateral lung texture enhancement, bilateral lung parenchyma diffuse mist shadow, bilateral lung (see multiple flocculents), and cord-like density increased shadow. (G, H) For the 21st-day performance: bilateral lungs (see multiple large patchy density increased shadow) and fuzzy boundary. (I, J) For the 36th-day performance: decreased brightness of both lungs, bilateral lungs (see multiple large patchy increased density shadow), and blurred boundaries (see air bronchogram).
case_images: fcimb-14-1347677-g003.jpg
case_images: PMC10964487_02_fcimb-14-1347677-g003.jpg
case_images: f3
case_images: Chest CT scan suggested bilateral lung infection, paraseptal emphysema of the upper lobe of both lungs, and a small amount of pericardial effusion ( Figures 3A, B ). Two days later, a chest CT scan showed aggravation of bilateral lung infection ( Figures 3C, D ). During the period, the chest CT scan showed extensive exudative changes in both lungs and local infectious lesions ( Figures 3E, F ). On day 21, the patient developed a fever again (39 C), and a chest CT scan showed extensive exudative changes in both lungs with a bilateral lung infection, which was significantly more advanced than before ( Figures 3G, H ). Tracheal intubation-assisted ventilation was performed, and a chest CT scan showed extensive exudative changes in both lungs, which progressed ( Figures 3I, J ).