case_images: PMC10392123_01
case_images: Thoracic computerized tomography scan before and after corticosteroid treatment. (A) No obvious abnormal tissue density shadow was observed before the commencement of the corticosteroid. (B) Two months after the commencement of a high dose corticosteroid, showing the new onset of right pleural effusion with increased density of adjacent lung parenchyma, as well as patchy infiltrates and cavitation in both lungs.
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case_images: PMC10392123_01_fmed-10-1226126-g0001.jpg
case_images: F1
case_images: A computed tomography (CT) scan of the thorax and abdomen did not reveal any significant changes at that time (Figure 1A). A CT scan of the thorax revealed right pleural effusion and bilateral infiltrates and cavitation (Figure 1B).
case_images: Timeline depicting rapid diagnosis of Nocardia kroppenstedtii infection by tNGS. HAP, hospital-acquired pneumonia; MALDI-TOF MS, matrix-assisted laser desorption ionization-time of flight mass spectrometry; tNGS, target next-generation sequencing; BAL, bronchoalveolar lavage; V-VECMO, Vein-vein extracorporeal membrane oxygenation.
case_images: fmed-10-1226126-g0002.jpg
case_images: PMC10392123_01_fmed-10-1226126-g0002.jpg
case_images: F2
case_images: Adult Still's disease was suspected and a high dose corticosteroid was commenced (Figure 2). Eight weeks after the commencement of the corticosteroid (the total amount of corticosteroid received was equivalent to 5,193 mg of prednisone), she developed severe and progressive shortness of breath, which rapidly evolved into type I respiratory failure (Figure 2). After 3 days of incubation, the aerobic bottles of two sets of blood cultures were positive for a Gram-positive rod which was also modified Ziehl-Neelsen stain positive (Figure 2).