case_images: PMC11406644_01
case_images: Peripheral blood smear showing small, mature-appearing lymphocytes with condensed chromatin (yellow arrow). Also present are smudge cells (red arrow).
case_images: 10.1177_11795476241278973-fig1.jpg
case_images: PMC11406644_01_10.1177_11795476241278973-fig1.jpg
case_images: fig1-11795476241278973
case_images: Subsequent peripheral smear examination demonstrated small, mature-appearing lymphocytes with condensed chromatin and smudge cells (Figure 1).
case_images: Resting 12-lead electrocardiogram showing sinus tachycardia.
case_images: 10.1177_11795476241278973-fig2.jpg
case_images: PMC11406644_01_10.1177_11795476241278973-fig2.jpg
case_images: fig2-11795476241278973
case_images: Resting 12-lead electrocardiogram revealed sinus tachycardia (Figure 2).
case_images: (A) Plain chest radiograph taken on the first day of admission. It demonstrates air under the right hemidiaphragm (yellow arrow) with the appearance of haustral folds within the air (red arrow). There is tracheal deviation to the left (blue arrow) as well as reduction of left lung volume (brown arrow). (B) Chest radiograph repeated on day 3 of admission still showing haustra within the air under the right hemidiaphragm (red arrow). This indicates the air is within the bowel lumen and not free (Chilaiditi's sign).
case_images: 10.1177_11795476241278973-fig3.jpg
case_images: PMC11406644_01_10.1177_11795476241278973-fig3.jpg
case_images: fig3-11795476241278973
case_images: Also noted were left tracheal deviation and reduced left lung volume (Figure 3) which were suggestive of pulmonary fibrosis.
case_images: Endoscopic image of the patient showing grade 2 esophageal varices.
case_images: 10.1177_11795476241278973-fig4.jpg
case_images: PMC11406644_01_10.1177_11795476241278973-fig4.jpg
case_images: fig4-11795476241278973
case_images: Upper gastrointestinal endoscopy was done later which showed grade 2 esophageal varices (Figure 4).