case_images: PMC11330855_01
case_images: Information of this case report has been organized into a timeline.
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case_images: The first cycle of chemotherapy "Docetaxel + Cisplatin + 5-fluorouracil" was performed on October 1 (Figure 1, green box). Alb 26g/L (Figure 1, blue box), as shown in Tables 1 and 2. After 5 days of empirical anti-infective treatment with meropenem, the patient's body temperature and PCT decreased, and WBC count returned to normal.  October 24, fiberoptic bronchoscopy showed obvious hyperemia of bilateral bronchial mucosa, more white phlegm and bronchial inflammation in the lumen. On October 27, next-generation sequencing technology (NGS) results of fiberoptic lavage fluid of the patient showed Mycobacterium abscess (Figure 1, red box). Considering that the patient had NTM-PD, clinical pharmacists recommended that antibacterial agents were switched to cefoxitin (4g q8h intravenous drop infusion, days 20-54, Figure 1, yellow box). Clinical pharmacists recommended sequential treatment with moxifloxacin after discharge (0.4g qd orally, days 55-85, Figure 1, yellow box).
case_images: (A and B) Multiple new voids, alert for lung abscesses. (C) and (D). Compared with (A and B), the cavity disappeared and the lesion shrank, but not fully absorbed. (E) and (F). The lesion site of the lower lobe of the right lung was significantly reduce.
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case_images: Chest CT examination was performed on October 22, which showed that the lower lobe of the right lung was infected with multiple new cavities, there were a few new lesions in the posterior and middle lobe of the upper lobe of the right lung (Figure 2A), and the possibility of lung abscess formation was warned. As the patient's cough and sputum were further improved, the reexamination of chest CT on October 31 indicated that the infection in the lower lobe of the right lung was absorbed more than before (Figure 2B) and the right pleural effusion was less.  Subsequent chest CT indicated further improvement of the right inferior lobe (Figure 2C). CT (Figure 2D) showed that significant reduction of the lesions in the lower lobe of the right lung and further reduction of a small amount of fluid in the original right thoracic cavity. Subsequent CT (Figure 2E and F) results indicated that the lesions were further reduced and the treatment of infection was successful.
case_images: Compared with (A), the above bones and surrounding soft tissues at the skull base of (B) were changed and the tumor invasion was smaller than before; Compared with (B), the mucosa of the left lateral wall of the nasopharynx in (C) was significantly thickened.
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case_images: The original lymph nodes in the neck have largely disappeared (Figure 3).