case_images: PMC8034239_01
case_images: Liver function changes and treatment flow chart.
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case_images: Approximately 1 week later, his ALT and AST levels decreased rapidly, and TBIL continued to deteriorate (Figure 1). Then, plasma exchange (PE) and a double plasma molecular absorption system (DPMAS) for blood purification were added, and cholestasis improved within a short time (Figure 1).
case_images: Changes in lung computed tomography scan. (a) At the beginning of the disease, the two lower lungs showed mild inflammation and exudation. (b) One month later, lung exudation aggravated; the clinical symptoms were chest tightness and shortness of breath. (c) Two weeks after treatment with methylprednisolone (1 mg/kg/day), the lesions were markedly absorbed, and the symptoms disappeared. (d) In the last week, pulmonary inflammation exacerbated, and mediastinal pneumothorax (arrow) appeared.
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case_images: Chest computed tomography (CT) scanning revealed interstitial inflammatory lesions in both lower lungs (Figure 2). Consequently, chest tightness and shortness of breath resolved, and pulmonary inflammation improved (Figure 2).
case_images: Pathological changes in a liver puncture. (a) Histological features of the liver were mainly lobular inflammation (arrow), with ductopenia, cholestasis of the capillary bile duct, and no obvious liver fibrosis (100, hematoxylin-eosin staining). (b) Panlobular hepatitis with lymphoplasmacytic infiltration (white arrow), hemorrhage of sinus endothelium (arrow), and cholestasis of capillary bile duct (red arrow) (200, hematoxylin-eosin staining).
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case_images: Liver biopsy revealed nonspecific immune injury (Figure 3).
case_images: Contrast-enhanced abdominal computed tomography showing heterogeneous enhancement of liver density.
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case_images: Contrast-enhanced abdominal CT showed heterogeneous enhancement of liver density (Figure 4).