case_images: PMC11228301_01
case_images: Daily course of the patient's treatment; curves of body temperature, ANC and CRP. Major events are indicated with arrows. Red dotted line shows ANC in peripheral blood. Blue line on the top shows body-temperature values. Blue line on the bottom shows CRP values. Horizontal color bars show the medications administered: IPM, imipenem; TZP, piperacillin-tazobactam; MEM, meropenem; VA, vancomycin; CAP, caspofungin; VRC, voriconazole; ISA, isavuconazole; AmB, amphotericin B; CRP, C-reactive protein; ANC, the absolute neutrophil count.
case_images: fmed-11-1397539-g001.jpg
case_images: PMC11228301_01_fmed-11-1397539-g001.jpg
case_images: fig1
case_images: Blood tests showed persistent neutropenia while CRP increased continually (Figure 1).
case_images: Serial T2-weighted FLAIR MRI images of lesions in the left temporal and parietal lobes (the red arrows). (A,B) Day 32. (C,D) Day171.
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case_images: PMC11228301_01_fmed-11-1397539-g002.jpg
case_images: fig2
case_images: Brain magnetic resonance imaging (MRI) revealed lesions in both the parietal and left temporal lobes (Figures 2A,B). Treatment with AmB continued until all lesions had almost disappeared or no longer reduced in size (Figures 3E-I, 2C,D, 4C,D).
case_images: Images of transesophageal echocardiography (TEE) (A) Day 43, a fusiform heterogeneous hypoechoic mass (11.5*6.0 mm) in the atrial septum, and a fluid dark area could be seen. (B) Day 43, a stream-like echo (11.0*3.7 mm) at the entrance of the superior vena cava. (C) Day 55, the mass (10.6*5.7 mm) in the atrial septum. (D) Day 55, a moderate echogenic mass (13.0*5.9 mm, basal width 4.6 mm) near the opening of the superior vena cava, with a large amplitude of oscillation during the heart rhythm cycle. A moderate echogenic mass (9.5*7.0 mm, base width 6.9 mm) near the orifice of the inferior vena cava. (E) Day 101, the abscess (6.25*4.47 mm) in the atrial septum. (F) Day 101, the moderate echoic mass (12.3*3.7 mm, base width 3.4 mm) near the opening of the superior vena cava, the mass near the opening of the inferior vena cava disappeared. (G) Day 129, the heterogeneous hypoechoic mass (6.35*4.47 mm) in the atrial septum. (H) Day 129, the moderate echogenic mass near the opening of the superior vena cava was not seen. (I) Day 235, the heterogeneous hypoechoic mass (6.18*4.07 mm) in the atrial septum.
case_images: fmed-11-1397539-g003.jpg
case_images: PMC11228301_01_fmed-11-1397539-g003.jpg
case_images: fig3
case_images: Transesophageal echocardiography (TEE) showed a heterogeneous hypoechoic mass (11.5 x 6 mm) in the atrial septum and an endocardial vegetation in the right atrium (11 x 3.7 mm) (Figures 3A,B). TEE on day 55 (Figures 3C,D), and several new skin nodules appeared during day 57-64. Treatment with AmB continued until all lesions had almost disappeared or no longer reduced in size (Figures 3E-I, 2C,D, 4C,D).
case_images: Contrast-enhanced CT images of chronic disseminated candidiasis. (A,B) Day 39, multiple small abscesses in the liver, spleen and both kidneys (the red arrows). (C,D) Day 171, abscesses almost disappeared.
case_images: fmed-11-1397539-g004.jpg
case_images: PMC11228301_01_fmed-11-1397539-g004.jpg
case_images: fig4
case_images: CT showed multiple small abscesses in the liver, spleen and both kidneys (Figures 4A,B). Chest CT showed bilateral multiple pulmonary small nodules similar to what was observed on day 15. Treatment with AmB continued until all lesions had almost disappeared or no longer reduced in size (Figures 3E-I, 2C,D, 4C,D).