case_images: PMC10158723_01
case_images: Bone marrow biopsy for diagnosis of essential thrombocythemia (ET) (A) Hematoxylin-Eosin (x400) staining of bone marrow biopsy specimen: normocellular bone marrow with enlarged megakaryocytes with hyperlobulated nuclei. Megakaryocytes were observed average of 3 to 4 per high power field. (B) Reticulin silver stain (x400) revealed increased number of mature megakaryocytes and myelofibrosis (grade 1).
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case_images: A BM biopsy revealed an increased number of mature megakaryocytes with hypersegmentation of nuclear lobes and myelofibrosis (grade 1) by reticulin silver staining (Figure 1), and a diagnosis of ET was made.
case_images: Computed tomography (CT) scan results. (A) Significantly increased bilateral pleural effusion, subcutaneous edema and progressive hepatosplenomegaly at admission; (B) CT scan one year after diagnosis of ET.
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case_images: C-reactive protein (CRP) and soluble interleukin-2 receptor (sIL-2R) levels were elevated to 7.8 mg/dL and 11,800 U/mL, respectively. CT showed significantly increased bilateral pleural effusion, subcutaneous edema, and progressive hepatosplenomegaly compared to that after the diagnosis of ET (Figure 2A, B).
case_images: Clinical course. Several antibiotic therapies and systemic general care were performed, and noradrenaline reduced gradually. However, the patient's platelet count decreased progressively. Initiation of steroid administration was scheduled on the 7th day of admission; however, the patient experienced rapidly progressing respiratory failure and consciousness disturbance since early morning. She further presented with a rapid fatal course and died after a few hours.
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case_images: However, she presented with a rapid fatal course and died a few hours later (Figure 3).