case_images: PMC9537471_01
case_images: Timeline of the clinical events and treatment strategies. MP, methylprednisolone; HC, hydrocortisone; IVIG, intravenous immunoglobulin.
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case_images: PMC9537471_01_fmed-09-964062-g0001.jpg
case_images: F1
case_images: The timeline of the clinical events and treatment strategies is shown in Figure 1.
case_images: Contrast-enhanced CT of the whole abdomen revealed liver cirrhosis, splenomegaly, ascites, and portal hypertension. Varicose veins in the lower part of the esophagus. Varicose veins around the fundus of the stomach and around the spleen (2 July).
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case_images: PMC9537471_01_fmed-09-964062-g0002.jpg
case_images: F2
case_images: A, and lower gastrointestinal bleeding (Figure 2). As the liver function worsened, according to the consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL), the disease progressed to acute-on-chronic liver failure.
case_images: The progression of skin lesions. (A) The patient developed a new congestive maculopapular rash, mainly on the trunk (7 July). (B) The patient has a dense rash on the back (9 July). (C) Blisters appeared on the lips (12 July). (D) The scab on the lips had improved (24 July). (E,F) Diffuse erythema and epidermal detachment on the back (24 and 26 July). (G,H) The detachment of the epidermis on the back gradually improved (29 July and 2 August).
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case_images: F3
case_images: In addition, the diffuse congestive rash was seen mainly on the trunk, accompanied by itching (Figure 3A). Blisters first appeared on the hands, feet, and lips and gradually spread to the limbs, shoulders, and neck (Figure 3C). After 5 days, there was no further necrosis and exfoliation of the skin rash and no new lesions (Figures 3D,E). The progression of the patient's skin lesions was shown in Figure 3.
case_images: Laboratory test indicators during the hospitalization of this patient. (A) White blood cells (x109/L), neutrophils (x109/L), lymphocytes (x109/L), and C-reactive protein (mg/L). (B) Alanine aminotransferase (U/L), aspartate aminotransferase (U/L), total bilirubin (mumol/L), and direct bilirubin (mumol/L). (C) International normalized ratio (INR) and prothrombin time (s). (D) CD3+CD4+AbsCnt and CD4/CD8 ratio.
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case_images: F4
case_images: T cells was <200 (Figure 4D). Important indicators were regularly reviewed throughout the treatment process (Figure 4).
case_images: (A,B) CT showed new inflammation and inflammatory nodules in the lingual segment of the right lung and the upper lobe of the left lung (16 August). (C,D) CT showed that the double pneumonia was less than before (5 September).
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case_images: F5
case_images: Cytomegalovirus, Epstein-Barr virus, Mycoplasma pneumoniae, and Chlamydia pneumoniae were all negative. The chest CT showed ground glass-like and grid-like changes (Figure 5). Considering that the patient's weakened immune system may cause opportunistic infections, the possibility of Pneumocystis carinii infection was high.