case_images: PMC11794048_01
case_images: (A) Chest CT scan shows increased pulmonary markings in both lungs, with scattered patchy shadows in the left lower lobe (Arrow indicated). The trachea and main bronchi were patent. No enlarged lymph nodes were seen in the mediastinum or hilum; (B) Enhanced CT of the head shows no apparent abnormalities.
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case_images: fig1
case_images: Upon admission, the chest CT scan showed scattered inflammation in the lower lobe of the left lung, but no abnormalities were observed in the head during the enhancement CT scan (Figure 1B).
case_images: CSF investigation and antimicrobial drugs. After adjusting the treatment, the CSF factors, including glucose content, protein content, WBC, and intracranial pressure, gradually returned to normal.
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case_images: fig2
case_images: The CSF analysis revealed positive Pandy test (protein 2,071 mg/L), intracranial pressure greater than 300 mmH2O, a white blood cell count (695 x 106/L) higher than the normal range, and glucose (1.2 mmol/L) and chloride(115 mmol/L) levels lower than the normal range (Figure 2). The detailed treatments are shown in Figure 2.
case_images: (A) Cerebrospinal fluid fungal culture flask annulation. After 12 days of continuous monitoring, the flask reported positivity (with an increasing growth curve). Cotton wool-like precipitation (indicated by red arrow) was visible in the bottle; (B,C) The cottony material was extracted and subjected to Gram staining and fluorescent staining separately. At high magnification (10x40), thick-walled spheroids and segmented hyphae were visible.
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case_images: fig3
case_images: Fortunately, 12 days after sampling (August 23), the fungus/mycobacteria culture flask showed positive results, and a cotton wool-like substance was produced in the flask (Figure 3A). Then, smear staining was performed, as shown in Figure 3, and thick-walled spheroids and segmented hyphae were observed using both Gram staining and Fluorescence staining.
case_images: Colony on SDA plates after incubation at different temperatures. Coccidioides is a temperature-dependent dimorphic fungus that exhibits different colony morphologies at different temperatures. (A) The colony grown at 28 C had suede to villi, gray-white, and tan to brown; (B) The colony grown at 35 C was in the white yeast phase. (C) Through lactophenol cotton blue staining, arthroconidia and a large number of rectangular, barrel-shaped arthroconidia with septa were observed. These are thin-walled, connected cells. The arthroconidia and thin-walled connected cells alternate to form chains (10x100).
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case_images: fig4
case_images: The hyphal stage was observable on the SDA plates at 28 C, whereas the yeast phase appeared at 35 C, consistent with the traits of biphasic fungi (Figures 4A,B). Articular spores, a critical characteristic of C. immitis, were clearly identified through colony Medan staining (Figure 4C).