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case_images: Chest imaging scan at admission, widespread high-density shadows in both lungs. The red arrow indicates the site of the high-density shadow.
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case_images: Chlamydia antigen test, HIV antibodies test, Treponema pallidum test, serum hepatitis A, B, C, E tests, nucleic acid testing for COVID-19, Brucella IgG antibody test, acid-fast stain, and polymerase chain reaction for tuberculosis in sputum, but all results were negative. Chest computed tomography (CT) revealed multiple nodules and cavities in both lung fields (Figure 1).
case_images: MRI results of right ankle joint on the second day of hospitalization. (A) T2WI coronal view of the right ankle joint. The red arrow shows significant soft tissue swelling around the right lateral malleolus. (B) T1WI sagittal view of the right ankle joint. The red arrow shows the formation of abscess in the right ankle joint. (C) T2WI sagittal view of right ankle joint. The red arrow shows the formation of abscess in the right ankle joint cavity.
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case_images: Infectious lesions of the right ankle joint with multiple abscesses were evident (Figure 2).  
case_images: Histopathological staining results of the right ankle joint puncture, scattered microrefraction transparent spherules in the interstitial tissue, suggesting cryptococcal infection. (A) Special staining periodic-acid silver methenamine (PAM) staining (x400). Red arrows indicate positive PAM staining. (B) Special staining periodic acid-Schiff (PAS) staining (x400). Red arrows indicate positive PAS staining.
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case_images: Special staining demonstrated: negative antacid staining, positive PAS, PAM, and AB staining (Figure 3).
case_images: MRI scan of the right ankle after 7 months of oral fluconazole treatment. (A) T2WI coronal view of the right ankle joint. The red arrow shows significant soft tissue swelling and absorption around the right lateral ankle. (B) T1WI sagittal view of the right ankle joint. The red arrow shows abscess absorption in right ankle joint cavity. (C) T2WI sagittal view of right ankle joint. The red arrow shows the absorption of abscess in the right ankle joint cavity.
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case_images: Following a 6-month treatment course, chest CT revealed a gradual reduction in lesions, while a MRI scan of the right ankle exhibited significant improvement (Figures 4 and 5).
case_images: The CT result of the patient's lungs after 9 months of treatment.Red arrows indicate that high-density shadows are significantly absorbed.
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case_images: Following a 6-month treatment course, chest CT revealed a gradual reduction in lesions, while a MRI scan of the right ankle exhibited significant improvement (Figures 4 and 5).