case_images: PMC11066154_01
case_images: (A, B) CT scan without and with contrast demonstrates liver "abscess-like" lesions. (C, D) CT scan without and with contrast demonstrates possible cholecystitis (red arrowhead). (E, F) Histopathological examination reveals vasculitis of hepatic arteries and resultant liver infarction (black arrowhead) (bar is 50 mum).
case_images: fimmu-15-1354349-g001.jpg
case_images: PMC11066154_01_fimmu-15-1354349-g001.jpg
case_images: f1
case_images: Abdominal CT demonstrated liver "abscess-like" lesions ( Figures 1A, B ) as well as possible cholecystitis ( Figures 1C, D ), and the histopathological examination of liver biopsy specimens confirmed the acute hepatic necrosis. Immune infiltration with a large number of neutrophils and fibrinoid necrosis were evident in some small- and medium-sized arteries, and adjacent hepatic tissues underwent ischemic infarction consequently ( Figures 1D-F ).
case_images: Positive correlation between clinical course and the administration of dexamethasone but not antibiotics. Laboratory reference range for indicators: CRP<3.0 mg/L; ALT: 9-50 U/L. CRP, C-reactive protein; ALT, alanine aminotransferase; DXM, dextromethorphan; ETP, ertapenem; MEM, meropenem; MTR, metronidazole; VAN, vancomycin; CMZ, cefmetazole; PDN, prednisone; MMF, mycophenolate mofetil; HCQ, hydroxychloroquine.
case_images: fimmu-15-1354349-g002.jpg
case_images: PMC11066154_01_fimmu-15-1354349-g002.jpg
case_images: f2
case_images: Unexpectedly, her symptoms worsened with a re-elevated fever peak and persistent coagulation disorders ( Figure 2 ). As the efficacy of low-dose dexamethasone given during plasma transfusion could not be excluded for transient improvement of the patient ( Figure 2 ), an immune dysregulation secondary to infection was considered.