28353613 Visualization

A 58 Age - year Age - old Age cotton Occupation farmer Occupation was presented Clinical_event to the West Nonbiological_location China Nonbiological_location Hospital Nonbiological_location of Nonbiological_location Sichuan Nonbiological_location University Nonbiological_location because of an over Duration 1 Duration - month Duration history of recurrent Detailed_description fever Sign_symptom ( between Lab_value 38 Lab_value and Lab_value 40 Lab_value   °C Lab_value ), productive Detailed_description cough Sign_symptom , and dyspnea Sign_symptom .
Prior to admission, he was diagnosed of pneumonia Disease_disorder and treated with latamoxef Medication , ofloxacin Medication , vancomycin Medication , and voriconazole Medication at local Nonbiological_location hospital Nonbiological_location .
However, no remission Sign_symptom of Sign_symptom symptoms Sign_symptom was observed.
Moreover, he was a hepatitis History B History virus History carrier History with a 10 History pack History - years History smoking History history History .
However, no History history History of History diabetes History mellitus, History tuberculosis, History and History use History of History glucocorticoids History in History the History past History were informed.
On admission Clinical_event , blood Diagnostic_procedure pressure Diagnostic_procedure , 145/95 Lab_value   mm Lab_value   Hg Lab_value ; heart Diagnostic_procedure rate Diagnostic_procedure , 120 Lab_value per Lab_value minute Lab_value ; respiratory Diagnostic_procedure rate Diagnostic_procedure , 30 Lab_value per Lab_value minute Lab_value ; and temperature Diagnostic_procedure , 39.3 Lab_value   °C Lab_value .
Physical Diagnostic_procedure examination Diagnostic_procedure revealed diminished Sign_symptom breath Sign_symptom sounds Sign_symptom , but no rales Sign_symptom were heard, and evaluation Diagnostic_procedure of Diagnostic_procedure other Diagnostic_procedure systems Diagnostic_procedure was unremarkable Lab_value except moderate Severity edema Sign_symptom of lower Biological_structure limbs Biological_structure .
Arterial Diagnostic_procedure blood Diagnostic_procedure gases Diagnostic_procedure analysis Diagnostic_procedure showed pH Diagnostic_procedure 7.361 Lab_value , PCO2 Diagnostic_procedure 53.5 Lab_value   mm Lab_value   Hg Lab_value , and PO2 Diagnostic_procedure 62.8 Lab_value   mm Lab_value   Hg Lab_value .
Laboratory data (Table ​(Table1)1) revealed leukocytosis Diagnostic_procedure of 49,500/mm3 Lab_value with 97.4% Lab_value neutrophils Lab_value , and elevated procalcitonin Diagnostic_procedure of 5.16 Lab_value  ng/mL.
Chest Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure , presence of nodules Sign_symptom , masses Sign_symptom , patchy Sign_symptom consolidations Sign_symptom , and bilateral Sign_symptom pleural Sign_symptom effusion Sign_symptom , is noted (Fig.1A).
Meanwhile, it was soon alerted in sputum Diagnostic_procedure smear Diagnostic_procedure with presence of filamentous Detailed_description , gram Detailed_description - positive Detailed_description , weakly Detailed_description acid Detailed_description - fast Detailed_description , and beaded Detailed_description bacilli Sign_symptom with possible diagnosis of Nocardia Disease_disorder infection Disease_disorder (Fig.1B, C).
Trimethoprim Medication - sulfamethoxazole Medication ( 3 Dosage pills Dosage per Dosage 6 Dosage   hours Dosage ) with noninvasive Detailed_description ventilation Therapeutic_procedure was promptly administered.
Sputum Diagnostic_procedure culture Diagnostic_procedure showed growth Lab_value of Lab_value numerous Lab_value bacteria Lab_value that were precisely determined to be N Sign_symptom otitidiscaviarum Sign_symptom by the method of mass Diagnostic_procedure spectroscopy Diagnostic_procedure on day Date 6 Date after Date admission Date (Fig.1D).
Antibiotics Medication were thus modified to amikacin Medication and imipenem Medication in addition to trimethoprim Medication - sulfamethoxazole Medication in accordance with the sensitivity test.
However, the patient was not improved Sign_symptom as expected and eventually died Outcome from severe Severity respiratory Sign_symptom insufficiency Sign_symptom on the 13th Date hospital Date day Date .