case_images: PMC9883690_01
case_images: Timeline of this case and diagnostic workup. (a) The INR increases with the control of infection. (b) The timeline recorded essential events of the patient during hospitalization.
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case_images: On admission, the patient was administered warfarin for thrombosis in the upper and lower pulmonary artery branches and between the calf muscles, and the INR was 1.13 (Figure 1). On the second day of admission (May 27), the INR was 1.06 (Figure 1), and the gene test results showed that the CYP2C9 activity of the patient was regular and the expression level of VKORC1 enzyme was decreased. Worse still, 2 days after admission (May 29), the patient had a fever with a body temperature of 39.4 C (Figure 1). Blood cell analysis on May 29 showed a neutrophil ratio (NEU%) of 75.7% and C-reactive protein at 42.1 mg/mL (Figure 1), indicating infection based on the hemogram. In the next few days, the patient had persistent fever, accompanied by a poor anticoagulant effect (INR < 2.00) (Figure 1). After starting meropenem treatment with warfarin, with the neutrophils and C-reactive protein levels of the patient returned to normal levels, the INR value of the patients also increased gradually from 1.36 (June 1) to 2.11, maintaining the best anticoagulant effect of warfarin on June 4 (Figure 1).
case_images: Data from mNGS. The location of the detected nucleic acid sequences of E. coli in blood, which yielded a total coverage of 7.2%.
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case_images: E. coli was detected in the peripheral blood in mNGS (242 unique reads) (Figure 2).