case_images: PMC11417000_01
case_images: (A) Upon admission, the patient had scattered reddish-brown papules on the whole body. (B) After treatment, the rash significantly subsided. (C) The bone marrow showed an increased proportion of plasma cells. (D) The hematopoietic tissue in the bone marrow was highly active (70-80% cellularity), accompanied by active proliferation of T lymphoid tissue and increased plasma cells (magnification x 40). (E) (Histopathology from lymph node puncture above the left clavicle) showed active proliferation of lymphoid tissue with a predominance of neutrophils, plasma cell infiltration, and tendencies toward inflammatory changes (magnification x 40).
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case_images: Scattered reddish-brown maculopapular lesions were observed throughout the body, with a higher concentration on the trunk, some exhibiting a ring-shaped appearance but without significant infiltration ( Figure 1A ). Bone marrow cytology indicated an increased ratio of plasma cells ( Figure 1C ), while histology showed highly active hematopoietic tissue with active proliferation of T lymphoid tissue and increased plasma cells ( Figure 1D ). Pathological examination of a lymph node biopsy from the left supraclavicular region revealed minimal lymphoid tissue proliferation with specific immunohistochemical staining patterns ( Figure 1E ). Concurrently, the widespread rash on the patient's body markedly improved ( Figure 1B ), and a follow-up examination showed reduced lymphadenopathy ( Figure 2H ).
case_images: (A, B) Chest CT (2024-01-11): Diffuse infiltration with consolidation in both lungs, accompanied by local cavitation. (C) Neck CT (2024-01-11): Destruction of the C6 vertebral body and spinous process with soft tissue mass formation. (D, E) After treatment, follow-up chest CT on 2024-01-16 showed significant absorption of lung patchy shadows compared to before, with a reduction in local cavities. (F) Head CT (2024-01-16): Localized low-density shadow in the frontal bone, suggesting bone destruction. (G) Neck ultrasound: Bilateral supraclavicular multiple lymph node enlargement, hypoechoic mass in the left supraclavicular region, measuring 3.84cm x 2.28cm; (H) Post-treatment on 2024.1.16, reduction in lymph nodes in the supraclavicular region. (I) On admission, enhanced CT examination of the chest revealed an irregular mass in the left upper mediastinum.
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case_images: Neck ultrasound showed bilateral supraclavicular lymphadenopathy and a hypoechoic mass in the left supraclavicular region ( Figure 2G ). Chest CT scan displayed diffuse infiltrates with consolidation in both lungs, along with local cavitation ( Figures 2A, B ). Enhanced CT examination of the chest revealed an irregular mass in the left upper mediastinum ( Figure 2I ). Neck CT scan indicated bone structure destruction at various sites, including the slope, left occipital condyle, C6 vertebral body, and spinous process, accompanied by soft tissue mass formation ( Figure 2C ). Head CT scan showed localized low-density shadows in the frontal bone and soft tissue density shadows with bone destruction at the slope ( Figure 2F ). On 2024-01-16, a chest CT scan revealed patchy opacities in both lungs, with partial absorption compared to the scan on 2024-01-11 ( Figures 2D, E ). Concurrently, the widespread rash on the patient's body markedly improved ( Figure 1B ), and a follow-up examination showed reduced lymphadenopathy ( Figure 2H ).
case_images: (A) Blood culture showed Talaromyces marneffei (TM) in the mold phase at 25 C, with characteristic red pigment production observed; (B) Culture of pus sample from left neck mass on Sabouraud's agar medium plate at 37 C showed yeast phase; (C) Blood culture sample showed TM under microscopy (magnification x 400); (D) Microscopic analysis of colonies grown on Sabouraud's agar medium plate at 25 C using lactophenol cotton blue staining revealed scattered, slightly asymmetric, typical double-helical broom-like fungal hyphae with short, smooth-walled, ellipsoidal, monoverticillate Penicillium conidiophores (magnification x 400); (E) Microscopic analysis at magnification x 1000; (F) Microscopic analysis of colonies grown on Sabouraud's agar medium plate at 37 C by lactophenol cotton blue staining (magnification x 400); (G) Examination of BALF using metagenomic next-generation sequencing (mNGS) revealed TM.
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case_images: Two days later (2024-01-12), the NGS results from the BALF showed TM ( Figure 3G ). Additionally, on the 5th day in the ICU (2024-01-15), culture results from the aspirated fluid of the left neck mass also confirmed TM ( Figures 3A, B, D-F ). Subsequent blood culture results from the patient also confirmed TM ( Figure 3C ).