case_images: PMC10611515_01
case_images: (A) Plain computed tomography revealed a post-pneumonia change in the lower lobe of the left lung in the process of healing, and (B) right-dominant bilateral pleural effusions, hepatosplenomegaly. (C) Normocellular marrow with mature megakaryocytes, but no fibrosis. (H&E staining, x100).
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case_images: Computed tomography revealed a post-pneumonia change in the lower lobe of the left lung during healing, right-dominant bilateral pleural effusions ( Figure 1A ), hepatosplenomegaly ( Figure 1B ), and ascites. Subsequently, platelets count slightly increased to greater than 30,000/muL, a level not typically seen in ITP patients responding to treatment.Repeated bone marrow biopsy after these treatments showed normal bone marrow hematopoietic cells and mature megakaryocytes with no malignant findings ( Figure 1C ), and the mildly elevated plasma thrombopoietin level was observed.
case_images: (A) Light microscopy shows diffuse global endocapillary proliferative changes with endothelial swelling and double contours in capillary walls (periodic acid-Schiff staining, x 400). (B) Electron microscopy shows endothelial cell swelling with expansion of the subendothelial space, and no immune complex deposition is observed in glomeruli.
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case_images: The most prominent renal biopsy findings were doubling of the glomerular basement membrane, mesangial and endocapillary proliferation, and subendothelial space expansion in light microscopy images ( Figure 2A ). Electron microscopy showed endothelial cell swelling with expansion of the subendothelial space, and no immune complex deposition was observed in glomeruli ( Figure 2B ).
case_images: Clinical course since hospitalization. PSL, prednisolone; NM, Nafamostat mesylate; rTM, recombinant thrombomodulin; TAZ/PIPC, tazobactam/piperacillin; H.pylori, helicobacter pylori; CRP, c-reactive protein. PLT, platelet; eGFR, estimated glomerular filtration rate.
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case_images:   Figure 3  summarizes the patient's clinical course.