28154287 Visualization

A 73 Age - year Age - old Age man Sex who had been diagnosed with type Disease_disorder 2 Disease_disorder diabetes Disease_disorder mellitus Disease_disorder at History 35 Date year Date of Date age Date , who had severe History diabetic Disease_disorder neuropathy Disease_disorder and diabetic Disease_disorder - ESRD Disease_disorder complained of respiratory Sign_symptom distress Sign_symptom and sudden Detailed_description chest Biological_structure pain Sign_symptom .
On the first Date day Date of treatment, he visited Clinical_event the emergency Nonbiological_location room Nonbiological_location .
A physical Diagnostic_procedure examination Diagnostic_procedure revealed that his body Diagnostic_procedure temperature Diagnostic_procedure was 35.4°C Lab_value , his heart Diagnostic_procedure rate Diagnostic_procedure was 90 Lab_value beats/min Lab_value with a regular Lab_value rhythm Lab_value ; and his blood Diagnostic_procedure pressure Diagnostic_procedure was 130/77 Lab_value mmHg Lab_value .
A physical Diagnostic_procedure examination Diagnostic_procedure revealed coarse Detailed_description crackles Sign_symptom on bilateral Detailed_description lung Diagnostic_procedure auscultation Diagnostic_procedure .
The laboratory Diagnostic_procedure data Diagnostic_procedure showed a WBC Diagnostic_procedure count of 8,800/μL Lab_value with a shift Lab_value to Lab_value the Lab_value left Lab_value ( neutrophils Diagnostic_procedure 82% Lab_value ), Hb Diagnostic_procedure 10.2 Lab_value g/dL Lab_value , blood Diagnostic_procedure urea Diagnostic_procedure nitrogen Diagnostic_procedure ( BUN Diagnostic_procedure ) 82.2 Lab_value mg/dL Lab_value , creatinine Diagnostic_procedure ( Cre Diagnostic_procedure ) 6.50 Lab_value mg/dL Lab_value , HbA1c Diagnostic_procedure 5.9% Lab_value , creatine Diagnostic_procedure kinase Diagnostic_procedure ( CK Diagnostic_procedure ) 189 Lab_value IU/L Lab_value , C Diagnostic_procedure - reactive Diagnostic_procedure protein Diagnostic_procedure ( CRP Diagnostic_procedure ) 8.51 Lab_value mg/dL Lab_value , brain Diagnostic_procedure - type Diagnostic_procedure natriuretic Diagnostic_procedure peptide Diagnostic_procedure ( BNP Diagnostic_procedure ) 127.4 Lab_value pg/mL.
A chest Biological_structure radiograph Diagnostic_procedure revealed perihilar Detailed_description consolidations Sign_symptom and air Detailed_description bronchograms Sign_symptom (Fig.1).
An electrocardiogram Diagnostic_procedure revealed ST Sign_symptom - segment Sign_symptom elevation Sign_symptom and poor Sign_symptom R Sign_symptom - wave Sign_symptom progression Sign_symptom in leads Detailed_description V1 Detailed_description - V3 Detailed_description , and echocardiography Diagnostic_procedure revealed apical Sign_symptom and Sign_symptom ventricular Sign_symptom asynergy Sign_symptom .
The patient was therefore diagnosed with acute Detailed_description myocardial Disease_disorder infarction Disease_disorder and congestive Detailed_description heart Disease_disorder failure Disease_disorder .
Coronary Biological_structure angiography Diagnostic_procedure was performed, revealing severe angiostenosis Sign_symptom in the septal Biological_structure branch Biological_structure .
PCI Therapeutic_procedure was therefore performed.
The patient required continuous Detailed_description maintenance Detailed_description dialysis Therapeutic_procedure .
On the following Date day Date , the patient went into cardiorespiratory Disease_disorder arrest Disease_disorder and cardiopulmonary Therapeutic_procedure resuscitation Therapeutic_procedure was performed, followed by mechanical Detailed_description ventilation Therapeutic_procedure .
On day Date 8 Date , ventilator Therapeutic_procedure assistance was discontinued.
However, the patient produced an increasing Lab_value volume Lab_value of sputum Sign_symptom , which began to appear purulent Lab_value .
Pseudomonas Sign_symptom aeruginosa Sign_symptom was identified from a sputum Diagnostic_procedure culture Diagnostic_procedure , and tazobactam/piperacillin Medication ( TAZ/PIPC Medication ) ( 4.5g Dosage q12h Dosage ) was administered.
Despite this therapy, the patient's respiratory Diagnostic_procedure condition Diagnostic_procedure worsened Lab_value and a chest Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) scan on day Date 15 Date revealed bilateral Detailed_description perihilar Detailed_description opacities Sign_symptom , pleural Disease_disorder effusion Disease_disorder , and atelectasis.(Fig.2).
We suspected the development of complications such as microbial Disease_disorder substitution Disease_disorder , pneumomycosis Disease_disorder and thus performed sputum Diagnostic_procedure culturing Diagnostic_procedure and serum Diagnostic_procedure fungal Diagnostic_procedure antigen Diagnostic_procedure tests.
The administration of TAZ/PIPC Medication was changed to meropenem Medication ( 0.5 Dosage g/day Dosage ).
On day Date 16 Date , the patient's serum Diagnostic_procedure tested positive Lab_value for Cryptococcus Diagnostic_procedure antigen Diagnostic_procedure .
On day Date 21 Date , cryptococcal Sign_symptom bodies Sign_symptom were identified in two Detailed_description sets Detailed_description of blood Diagnostic_procedure cultures Diagnostic_procedure and liposomal Medication amphotericin Medication B Medication ( L Medication - AMB Medication ) ( 3 Dosage mg/kg/day Dosage ) was administered.
On day Date 23 Date , cryptococcal Sign_symptom bodies Sign_symptom were identified in the sputum Diagnostic_procedure , cerebrospinal Diagnostic_procedure fluid Diagnostic_procedure , and bilateral Detailed_description pleural Diagnostic_procedure effusion Diagnostic_procedure (Fig.3).
The patient was therefore diagnosed with disseminated Detailed_description cryptococcosis Disease_disorder .
On day Date 25 Date , brain Biological_structure CT Diagnostic_procedure revealed the absence of intracranial Biological_structure hypertension Sign_symptom and a brain Biological_structure abscess Disease_disorder .
The patient was not infected with human Disease_disorder immunodeficiency Disease_disorder virus Disease_disorder ( HIV Disease_disorder ).
The administration of L Medication - AMB Medication ( 3 Dosage mg/kg/day Dosage ) was continued.
On day Date 31 Date , chest Biological_structure CT Diagnostic_procedure revealed a solitary Detailed_description nodule Sign_symptom in the left Biological_structure lingular Biological_structure segment Biological_structure for the first time, which was suspected to be a pulmonary Biological_structure cryptococcus Disease_disorder lesion Disease_disorder (Fig.4a).
After Date several Date days Date , all of the sputum Diagnostic_procedure , blood Diagnostic_procedure , bilateral Detailed_description pleural Diagnostic_procedure effusion Diagnostic_procedure , and cerebrospinal Diagnostic_procedure fluid Diagnostic_procedure cultures Diagnostic_procedure tested negative Lab_value .
On day Date 52 Date , chest Biological_structure CT Diagnostic_procedure revealed another lung Biological_structure nodule Sign_symptom in the right Biological_structure pulmonary Biological_structure apical Biological_structure region Biological_structure .
These nodules Sign_symptom gradually decreased Lab_value in Lab_value size Lab_value until day Date 79 Date (Fig.4b and c).
Although L Medication - AMB Medication was considered effective, the C Diagnostic_procedure - reactive Diagnostic_procedure protein Diagnostic_procedure level remained elevated Lab_value and the bilateral Detailed_description pleural Disease_disorder effusion Disease_disorder continuously increased.
The patient lost Sign_symptom consciousness Sign_symptom because of decreased Lab_value vital Diagnostic_procedure capacity Diagnostic_procedure with increasing bilateral Detailed_description pleural Disease_disorder effusion Disease_disorder and was diagnosed with CO2 Disease_disorder narcosis Disease_disorder .
The patient's general Diagnostic_procedure condition Diagnostic_procedure deteriorated Lab_value .
On day Date 87 Date , ventricular Disease_disorder fibrillation Disease_disorder occurred and the patient died Clinical_event .
Autopsy Diagnostic_procedure was not performed.
At Date a Date later Date date Date , the Cryptococcus Detailed_description isolate Detailed_description was identified and classified as Cryptococcus Disease_disorder neoformans Disease_disorder var. Disease_disorder grubii Disease_disorder (serotype Disease_disorder A) Disease_disorder by a genetic Diagnostic_procedure analysis Diagnostic_procedure .