case_images: PMC10612464_01
case_images: (a) Trend graph of ALT and AST changes during the patient's hospitalization. (b) Trend graph of TB and DB changes during the patient's hospitalization. (c) Trend graph of WBC changes during the patient's hospitalization. (d) Trend graph of RBC changes during the patient's hospitalization. (e) Trend graph of PLT changes during the patient's hospitalization. Horizontal coordinates indicate date, the vertical coordinate indicates the value.. AST: aspartate transaminase; ALT: alanine transaminase; TB: total bilirubin; DB: direct bilirubin; WBC: white blood cell; RBC: red blood cell; PLT: platelet.
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case_images: Aspartate transaminase 778.7 IU/L (15-40 IU/L), alanine transaminase 371.6 IU/L (9-50 IU/L), total bilirubin 96.7 mumol/L (<=26 mumol/L), direct bilirubin 61.2 mumol/L (<=4 mumol/L; Figure 1(a) and (b)), gamma-glutamyl transferase 191.7 IU/L (10-60 IU/L), and ALP 351.8 IU/L (45-125 IU/L). Blood work revealed white blood cell (WBC) count 2.7 x 109/L (3.50-9.50 x 109/L), red blood cell count 4.3 x 1012/L (4.50-5.80 x 1012/L), and PLT count 45 x 109/L (125-350 x 109/L; Figure 1(c-e)). Trends in the laboratory test indicators during the patient's hospitalization can be observed in Figure 1.
case_images: MRCP + plain scan of the liver, bile, and spleen was performed: Severe edema of the gallbladder wall and disappearance of intrahepatic bile ducts (red arrow).
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case_images: Magnetic resonance cholangiopancreatography (MRCP) revealed edema of the gallbladder wall and disappearance of intrahepatic bile ducts (Figure 2). Magnetic resonance imaging (MRI) revealed severe edema of the gallbladder wall and disappearance of the intrahepatic bile ducts, which are typical features of VBDS (Figure 2).
case_images: Bone marrow cell morphology report: granulocytes occupy 40.5% of nucleated cells, erythrocytes occupy 33.5% of nucleated cells, lymphocytes occupy 17.5% of nucleated cells, phagocytes occupy 3.5% of nucleated cells, with phagocytosed material, including mature red blood cells and platelets.
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case_images: On July 18, a bone marrow biopsy revealed the presence of haemophilus cells (Figure 3), meeting criteria (1), (3), (4), (5), (6), and (8)of the updated HPS-2004 criteria.