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Abstract
[1] In recent years, the incidence of S. apiospermum infection has shown an increasing trend in immune-compromised populations, including HIV/AIDS patients, organ transplant recipients, and patients who have received corticosteroids or immunosuppressive drugs for a long period of time. At admission, the patient was in mild-coma, had lip cyanosis, and auscultatory coarse breath sounds in both lungs with high-pitched wet crackles. Arterial blood gas analysis showed pH 7.28, PaCO 2 27.5 mmHg and PaO 2 95.3 mmHg (FiO 2 60%). A second pulmonary CT taken on day 18 showed disease progression in both lungs [Figure 1]b. On day 21, he suffered from headache and fever with temperature 39C again, although no nausea or vomiting was noted. Lumbar spine MRI was performed on day 57 and showed that there were pathological changes in L 4 and L 5 vertebrae and L 4 /L 5 and L 5 /S 1 intervertebral disks, indicating vertebral osteomyelitis and intervertebral disk inflammation [Figure 3]. {Figure 2}{Figure 3} The patient was finally diagnosed with multiple S. apiospermum infection based on the history of near-drowning associated with contaminated water, lesions in the lungs, central nervous system, eyes, knee joint, lumbar vertebrae, the positive cultures of S. apiospermum of sputum and especially the later onset of knee joint effusion., Anti-fungal treatment was adjusted based on the symptoms, the level of (1-3)-β-D-glucan (from 20.5 to 170 pg/ml) and fungal culture results. During this period, he received multiple imaging examinations including plain chest X-ray, chest CT [Figure 1]c and d,...