case_images: PMC8440108_01
case_images: Chest CT showing thickening of the pleura and a nodule at the apex of the left lobe.
case_images: CRIRH2021-7842049.001.jpg
case_images: PMC8440108_01_CRIRH2021-7842049.001.jpg
case_images: fig1
case_images: Chest computed tomography (CT) showed thickening of the pleura and a nodule at the apex of the left lobe (Figure 1).
case_images: Chest CT image at the upper lobe level (a), at the carina level (b), and at the lower lobe level (c) on admission. Chest CT showed grand glass opacity in all fields with consolidation in the right and left lungs.
case_images: CRIRH2021-7842049.002.jpg
case_images: PMC8440108_01_CRIRH2021-7842049.002.jpg
case_images: fig2
case_images: CT scan showed grand glass opacity in all fields with consolidation within the right and left lungs (Figure 2) and mildly swollen kidneys without hydronephrosis.
case_images: The clinical course. CRP, C-reactive protein; INH, isoniazid; LVFX, levofloxacin; MEPM; meropenem; mPSL, methylprednisolone; PSL, prednisolone; SM, streptomycin; TB, tuberculosis.
case_images: CRIRH2021-7842049.003.jpg
case_images: PMC8440108_01_CRIRH2021-7842049.003.jpg
case_images: fig3
case_images: The clinical course is shown in Figure 3.
case_images: Excessive neutrophil accumulation with necrosis in the lung ((a) x40; (b) x100). Numerous acid-fast bacilli with Ziehl-Neelsen stain ((c) x400) and round to oval cysts with Grocott's methenamine silver nitrate stain ((d) x400). Granulomas present in the liver (e), spleen (f), kidney (g), pancreas (h), and adrenal gland (i).
case_images: CRIRH2021-7842049.004.jpg
case_images: PMC8440108_01_CRIRH2021-7842049.004.jpg
case_images: fig4
case_images: Ziehl-Neelsen staining aided the detection of acid-fast bacilli (Figure 4(a)-4(c)). A few numbers of pneumocystis organisms were identified in the lungs using Grocott's methenamine silver nitrate staining (Figure 4(d)). Numerous granulomas were present as extrapulmonary lesions in the liver, spleen, kidneys, pancreas, and adrenal glands (Figures 4(e)-4(i)).