case_images: PMC11368741_01
case_images: Images demonstrating rash and relief. (A) erythematous rash confluent macules over face (Day 7 of illness); (B) erythematous macules around periorbital areas (Day 12 of illness); (C), rash over face, especially periorbital areas, partially resolved (Day 16 of illness); (D) resolution of rash by four-month follow-up.
case_images: fped-12-1381493-g001.jpg
case_images: PMC11368741_01_fped-12-1381493-g001.jpg
case_images: F1
case_images: His rash was distributed on the face (Figure 1A), and the fever fluctuated between 38.5 C and 39.0 C despite conventional antibiotic treatment (cefotaxime sodium for 3 days, meropenem for 4 days). After admission, the rash gradually spread to the chest, abdomen, soles and around the orbit (Figure 1B). The facial rash partially resolved with only ordinary moisturizing skin cream (Figure 1C), and his EEG normalized. Follow-up after four months demonstrated that the rash had completely resolved (Figure 1D); cranial MRI showed bilateral widening of the anterior frontal space, thin development of the corpus callosum, and a slight decrease in white matter in the brain.
case_images: Natural killer cell activity test (reference range: greater than 15.11%). (A) Natural apoptosis background of single target cells; (B) The killing ratio of natural killer cells to target cells in the submitted samples.
case_images: fped-12-1381493-g002.jpg
case_images: PMC11368741_01_fped-12-1381493-g002.jpg
case_images: F2
case_images: Laboratory investigation revealed a white blood cell count of 1.70 x 109 /L (reference range: 5.6-14.5*109 /L); hemoglobin level, 66 g/L (reference range: 99-196 g/L); platelet count, 77 x 109 /L (reference range: 203-653*109 /L); neutrophil cell count, 0.4 x 109 /L (reference range: 0.8-6.1*109 /L); aspartate aminotransferase, 192 U/L (reference range: 21-80 U/L); albumin, 21 g/L (reference range: 35-50 g/L); lactate dehydrogenase, 1,530 U/L (reference range: 100-240 U/L); fibrinogen level, 0.6 g/L (reference range: 1.5-3.76 g/L); activated partial thromboplastin time, 58.3s (reference range: 25.1-40.7 s); ferritin level, 983 ng/ml (reference range: 144-600 ng/ml); triglycerides level, 3.35 mmol/L (reference range: 0.32-0.99 mmol/L); a soluble interleukin-2 receptors level of 3,081 u/ml (reference range: 223-710 u/ml); Flow assay showed natural killer (NK) cells activity at the low limit of the normal range (Figure 2), CD107a excitation assay showed defective degranulation of NK cells, and degranulation of cytotoxic T-cell (CTL) was normal (Figure 3).
case_images: Cd107a excitation assay.
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case_images: PMC11368741_01_fped-12-1381493-g003.jpg
case_images: F3
case_images: Laboratory investigation revealed a white blood cell count of 1.70 x 109 /L (reference range: 5.6-14.5*109 /L); hemoglobin level, 66 g/L (reference range: 99-196 g/L); platelet count, 77 x 109 /L (reference range: 203-653*109 /L); neutrophil cell count, 0.4 x 109 /L (reference range: 0.8-6.1*109 /L); aspartate aminotransferase, 192 U/L (reference range: 21-80 U/L); albumin, 21 g/L (reference range: 35-50 g/L); lactate dehydrogenase, 1,530 U/L (reference range: 100-240 U/L); fibrinogen level, 0.6 g/L (reference range: 1.5-3.76 g/L); activated partial thromboplastin time, 58.3s (reference range: 25.1-40.7 s); ferritin level, 983 ng/ml (reference range: 144-600 ng/ml); triglycerides level, 3.35 mmol/L (reference range: 0.32-0.99 mmol/L); a soluble interleukin-2 receptors level of 3,081 u/ml (reference range: 223-710 u/ml); Flow assay showed natural killer (NK) cells activity at the low limit of the normal range (Figure 2), CD107a excitation assay showed defective degranulation of NK cells, and degranulation of cytotoxic T-cell (CTL) was normal (Figure 3).
case_images: Dynamics of laboratory indices during treatment and follow-up (A) and phagocytosis by macrophages in the bone marrow (B) Red arrows point to phagocytosed red blood cells; blue arrows point to phagocytosed platelets.
case_images: fped-12-1381493-g004.jpg
case_images: PMC11368741_01_fped-12-1381493-g004.jpg
case_images: F4
case_images: Initial bone marrow aspiration (3 days after admission) revealed no abnormalities; however, repeat bone marrow aspiration (day 10 after admission) showed hemophagocytosis (Figure 4).