case_images: PMC11683261_01
case_images: The chest CT imagines at different times: A, C&E indicated lung windows of lung CT at 1st, 14th, 28th day. B, D&F indicated mediastinum windows of lung CT at 1st, 14th, 28th day.
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case_images: The emergent chest computer tomography (CT) showed local consolidation in the lower lobe of the right lung and multiple diffuse bilateral pneumonia (Fig. 1). At the 14th day of admission to the hospital, the chest CT showed bilateral infiltration was more extended than the initial chest CT findings (Fig. 1A &B).
case_images: The data from mNGS, regular PCR and cell phenotype. The location of detected nucleic acid sequences in T. whipplei, which yielded a total coverage of 0.7168 %. B.The bright bands were T. whipplei amplified products in BALF, blood and nasopharynx. C. The bright bands were T. whipplei amplified products in nasopharynx from the patient's husband and parents. D.The cell phenotype of BALF: neutrophils and alveolar macrophage respectively account for 45 % and 5 %.
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case_images: Thus, we send BALF to perform metagenomics next-generation sequencing (mNGS) for rapidly detecting possible pathogenic microorganism. mNGS results of BALF revealed 127 unique sequencing reads of T. whipplei, covering 0.7168 % of the nucleotide sequences (Fig. 2A). Thus, moxifloxacin and peramivir were discontinued. The regular polymerase chain reaction (PCR) analysis was also performed to confirm the presence of T. whipplei in BALF by sequencing of 16S ribosomal DNA (rDNA) (Fig. 2B). T. whipplei was also detected in the nasopharynx from her husband and parents (Fig. 2C) via regular PCR, but not in stool (Fig. 2C). The cell phenotype analysis of BALF showed neutrophils 45 % and alveolar macrophage 5 % (Fig. 2D).