case_images: PMC11288832_01
case_images: Computed tomography of the chest. (A1, B1) Upon admission, the scan (2023-02-04) revealed inflammatory lesions in the right lower lobe of the lung, along with localized consolidation. Furthermore, minimal pleural effusion was noted in the right pleural cavity and interlobar fissure. Bilateral pulmonary emphysema was also present. (A2, B2) A subsequent scan (2023-02-16), conducted after 12 days of antibiotic therapy, demonstrated persistent pulmonary lesions similar to those observed on the initial admission CT scan, with no apparent improvement. (A3, B3) A follow-up scan (2023-02-22), conducted after 6 days of antifungal therapy, exhibited improvement of pulmonary inflammation and pleural effusion compared to previous scans. (A4, B4) After 22 days of antifungal treatment, a follow-up scan (2023-03-10) demonstrated further absorption of the lung lesions, with only a small amount of residual fibrous streaky changes remaining.
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case_images: PMC11288832_01_fmed-11-1424586-g0001.jpg
case_images: F1
case_images: A computed tomography (CT) scan revealed inflammatory lesions and local consolidation in the right lower lobe, with a small amount of pleural effusion on the right side and bilateral lung emphysema (Figures 1A1, B1). On day 12, ESR and hsCRP did not significantly decrease, the patient's symptoms did not improve, and repeated chest CT showed no significant improvement (Figures 1A2, B2).
case_images: Metagenomic next-generation sequencing. Coverage graph of P.digitatum (36 reads, relative abundance value of 67.92%). The abscissa represents the genome position, the left ordinate is the number of reads of the pathogen aligned on the genome location (The number of map reads shown in green), and the right ordinate is the coverage and average sequencing depth at the corresponding position (coverage and depth, the red and blue lines in the figures).
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case_images: F2
case_images: The mNGS (SimcereDx, Nanjing, China) results were reported on the 2nd day of sequencing (day 11), showing the presence of Penicillium digitatum (36 reads with a relative abundance value of 67.92%) (Figure 2). On day 12, ESR and hsCRP did not significantly decrease, the patient's symptoms did not improve, and repeated chest CT showed no significant improvement (Figures 1A2, B2).
case_images: Penicillium digitatum was cultured for fungi in Sabouraud agar medium in a BALF sample at 28 C. (A-C) Positive colonies were cultured and stained with a lactophenol cotton blue staining solution. Under the microscope, the colonies showed a range of branching patterns, from simple to complex. The conidiophores had undergone multiple branchings and produced several rounds of symmetrical or asymmetrical small branches resembling brooms. (D) The spores of this Penicillium are typically elliptical under the microscope. (E) After 5 days of culture, the initial growth of Penicillium was observed, with white colonies exhibiting a velvety texture. (F) With the prolongation of growth time, the color of the colony gradually changes to light green or green, and liquid droplets appear in the center. Scale bars: 10 mum.
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case_images: PMC11288832_01_fmed-11-1424586-g0003.jpg
case_images: F3
case_images: On day 16, Penicillium species were found in the fungal culture of the first BALF, and on day 19, the second BALF fungal culture also supported the growth of the same type of Penicillium species (Figure 3).