PMC8222916_01
Chest computed tomography scan on day 2 (A, B), day 8 (C, D) and day 17 (E, F).
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Chest computed tomography (CT) revealed diffuse infiltration and patchy shadows in both lungs and bilateral pleural effusion ( Figures 1A, B ). Her condition improved daily, along with the increase in oxygenation index and improvement in chest CT gradually ( Figures 1C-F ); she was withdrawn from the ventilator on day 10 and was discharged on day 19.
Changes of bone marrow smear before (A) and after (B) treatment 1000x. Picture A showing neutrophils (black arrow) and red cells (red arrow) engulfed by macrophages; picture B showing no phagocytosis.
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And there was no evidence of M. tuberculosis in bone marrow ( Figure 2A ). The second bone marrow aspiration showed no hemophagocytosis ( Figure 2B ).
Pathology of placenta biopsy showing caseating tuberculous granulomas. (A) Caseous necrosis in a placenta (H&E staining, 200x). (B) Granuloma was found in the placenta, which was comprised of proliferative epithelioid cells. A Langhans multinucleated giant cells was found at the edge of the nodule (arrow) (H&E staining, 200x). (C) CD68 immunohistochemical staining highlighted the proliferative epithelioid cells as well as the Langhans multinucleated giant cell (CD68 immunostaining, 200x). (D) The proliferative epithelioid cells and the Langhans multinucleated giant cell were negative for PLAP, while the placental syncytiotrophoblast cells were positive for PLAP (PLAP immunostaining, 200x).
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As the embryo died on day 5, she underwent a medical abortion, and caseating tuberculous granulomas were found in the placenta ( Figure 3 ).
Treatment and observation during hospitalization. Picture (A) showing body temperature and treatment; picture (B) showing white blood cell count and platelet count; picture (C) showing serum fibrinogen and ferritin; picture (D) showing C-reactive protein and interleukin-6, during hospitalization.
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The patient responded well to the treatment, with marked improvement in fever and cytopenia ( Figures 4A, B ). Along with the resolution of hypofibrinogenemia and hyperferritinemia ( Figure 4C ), the concentrations of CRP and interleukin (IL)-6 decreased continuously ( Figure 4D ).