Figure 4.

Dynamic changes in imaging examinations of patients during follow-up. Imaging examination of P1 revealed that the axillary and mediastinal lymph nodes were enlarged (A.1). After oral itraconazole and anti-tuberculous therapy for nearly 2 months, chest CT re-examination showed that the axillary and mediastinal lymph nodes were still enlarged (A.2). A lymph node biopsy was performed on April 19, 2022, and mNGS indicated high reads of T. marneffei. Antifungal therapy was adjusted to amphotericin B for 2 weeks, followed by oral itraconazole. One month later, the imaging examination suggested that the lymph nodes were smaller than before (A.3). Chest CT of P3 suggested pneumonia and partial consolidation of the left lung with slight pleural effusion in the acute phase (B.1), and the patient received oral itraconazole antifungal combined with anti-tuberculosis therapy. Chest CT re-examination revealed significant improvement in the lungs after 3 months (B.2) and 8 months (B.3). Abdominal CT of P5 indicated hepatosplenomegaly and multiple abnormal lesions at the beginning (C.1). He received intravenous voriconazole treatment for 25 days and then oral voriconazole. The multiple abnormal lesions improved after treatment for 2 weeks (C.2) and 3.5 months (C.3).